Provider Demographics
NPI:1760630925
Name:LEINEN, KATHLEEN A (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:LEINEN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1045 CENTRAL PKWY N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5085
Mailing Address - Country:US
Mailing Address - Phone:210-536-9591
Mailing Address - Fax:904-425-2919
Practice Address - Street 1:12602 TOEPPERWEIN RD
Practice Address - Street 2:SUITE #100
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3269
Practice Address - Country:US
Practice Address - Phone:210-654-0030
Practice Address - Fax:855-278-4550
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN0919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209713102Medicaid
TXN0919OtherTX LICENSE
TX209713102Medicaid