Provider Demographics
NPI:1205955374
Name:LEESE, PHILIP TAYLOR (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:TAYLOR
Last Name:LEESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 W 115TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1553
Mailing Address - Country:US
Mailing Address - Phone:913-708-7555
Mailing Address - Fax:913-708-7607
Practice Address - Street 1:6700 W 115TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1553
Practice Address - Country:US
Practice Address - Phone:913-708-7555
Practice Address - Fax:913-708-7607
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine