Provider Demographics
NPI:1740448125
Name:LEONARDS, ANDREA J (DPM)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:LEONARDS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 LAKEWOOD DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1883
Mailing Address - Country:US
Mailing Address - Phone:985-385-2616
Mailing Address - Fax:985-385-2618
Practice Address - Street 1:1302 LAKEWOOD DR STE 202
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1883
Practice Address - Country:US
Practice Address - Phone:985-385-2616
Practice Address - Fax:985-385-2618
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM.200026213ES0103X
IL016.005336213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1801569Medicaid
LAP00802983OtherMEDICARE RAILROAD
LA4M171DU99Medicare PIN