Provider Demographics
NPI:1760821755
Name:LEISINGER, ELISE (DO)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:LEISINGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:MIKALOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:BAYNE-JONES COMMUNITY HOSPITAL 1585 THIRD ST.
Mailing Address - Street 2:
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BAYNE-JONES COMMUNITY HOSPITAL 1585 THIRD ST.
Practice Address - Street 2:
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459
Practice Address - Country:US
Practice Address - Phone:337-531-3118
Practice Address - Fax:337-531-3025
Is Sole Proprietor?:No
Enumeration Date:2013-06-23
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine