Provider Demographics
NPI:1689014425
Name:LEKA, BRUNI (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUNI
Middle Name:
Last Name:LEKA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11410 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2809
Mailing Address - Country:US
Mailing Address - Phone:215-698-6133
Mailing Address - Fax:215-698-6144
Practice Address - Street 1:11410 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2809
Practice Address - Country:US
Practice Address - Phone:215-698-6133
Practice Address - Fax:215-698-6144
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006479213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1710335476OtherNPI
PA81-1061640OtherTIN
PA30046774OtherDRIVER'S LICENSE