Provider Demographics
NPI:1831148394
Name:LEISTNER, HEDI LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:HEDI
Middle Name:LOUISE
Last Name:LEISTNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 TIMBERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4734
Mailing Address - Country:US
Mailing Address - Phone:727-771-7606
Mailing Address - Fax:
Practice Address - Street 1:108 TIMBERVIEW DR
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4734
Practice Address - Country:US
Practice Address - Phone:727-776-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120739-12080P0214X
NMMD2015-01992080P0214X
CT0460122080P0214X
FLME1384182080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1-01033090Medicaid
NY1-01033090Medicaid
37A41Medicare ID - Type Unspecified