Provider Demographics
NPI:1245506864
Name:LEISINGER, DANIEL JAY (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAY
Last Name:LEISINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2055 KIMBALL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5047
Mailing Address - Country:US
Mailing Address - Phone:319-272-0000
Mailing Address - Fax:319-272-1329
Practice Address - Street 1:2055 KIMBALL AVE STE 400
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5047
Practice Address - Country:US
Practice Address - Phone:319-272-0000
Practice Address - Fax:319-272-1329
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA4279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1245506864Medicaid
IA719260524Medicare PIN