Provider Demographics
NPI:1851787196
Name:LEANDER FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:LEANDER FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIKKALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-481-0625
Mailing Address - Street 1:3550 LAKELINE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3504
Mailing Address - Country:US
Mailing Address - Phone:678-481-0625
Mailing Address - Fax:
Practice Address - Street 1:3550 LAKELINE BLVD
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3504
Practice Address - Country:US
Practice Address - Phone:678-481-0625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty