Provider Demographics
NPI:1881698348
Name:LEIKER, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:LEIKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7111 E 21ST STREET N
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206
Mailing Address - Country:US
Mailing Address - Phone:316-684-2851
Mailing Address - Fax:316-686-7338
Practice Address - Street 1:7111 E 21ST ST N
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-684-2851
Practice Address - Fax:316-686-7338
Is Sole Proprietor?:No
Enumeration Date:2005-06-11
Last Update Date:2012-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-26415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS101600OtherBLUE CROSS INDIVIDUAL
KS100416440AMedicaid
KS080183217OtherRAILROAD MEDICARE
KS100314730BMedicaid
KS110718OtherBLUECROSS GROUP
KS621762OtherFIRSTGUARD
KS080183217OtherRAILROAD MEDICARE
KS110718OtherBLUECROSS GROUP
KS101600OtherBLUE CROSS INDIVIDUAL