Provider Demographics
NPI:1255406724
Name:LEEHEY, KEVIN JOHN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOHN
Last Name:LEEHEY
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 1:1980 E FORT LOWELL RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719
Mailing Address - Country:US
Mailing Address - Phone:520-296-4280
Mailing Address - Fax:520-296-3835
Practice Address - Street 1:1980 E FORT LOWELL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-296-4280
Practice Address - Fax:520-296-3835
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ122132084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
O44151Medicare UPIN
MD12213Medicare ID - Type Unspecified