Provider Demographics
NPI:1720084197
Name:CATTOLICO, LEON MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:MICHAEL
Last Name:CATTOLICO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6743
Mailing Address - Country:US
Mailing Address - Phone:928-634-5551
Mailing Address - Fax:928-634-5604
Practice Address - Street 1:1200 N. BEAVER
Practice Address - Street 2:PAYER CREDENTIALING
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-213-6235
Practice Address - Fax:928-213-6292
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-3268-L207Q00000X
AZ3427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ471467Medicaid
AZ3427OtherLICENSE
AC-6555695OtherD.E.A.
AZ471467Medicaid
AZZ193054Medicare PIN