Provider Demographics
NPI:1013201623
Name:LEESTMA, MICAH JAMES (DO)
Entity type:Individual
Prefix:MR
First Name:MICAH
Middle Name:JAMES
Last Name:LEESTMA
Suffix:
Gender:
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:519 N HALLECK ST
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-9553
Mailing Address - Country:US
Mailing Address - Phone:219-987-7750
Mailing Address - Fax:219-987-5750
Practice Address - Street 1:519 N HALLECK ST
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310-9553
Practice Address - Country:US
Practice Address - Phone:219-987-7750
Practice Address - Fax:219-987-5750
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004123A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine