1821084146 NPI number — DR. ELLEN LOUISE LEEKE D.O.

Table of content: DR. ELLEN LOUISE LEEKE D.O. (NPI 1821084146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821084146 NPI number — DR. ELLEN LOUISE LEEKE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEEKE
Provider First Name:
ELLEN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARTRICH
Provider Other First Name:
ELLEN
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821084146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 THE CROFTERS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRETHAM
Provider Business Mailing Address State Name:
CAMBRIDGESHIRE
Provider Business Mailing Address Postal Code:
CB6 3NF
Provider Business Mailing Address Country Code:
GB
Provider Business Mailing Address Telephone Number:
011441353648962
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FAMILY PRACTICE, 48TH MDG/MDOS/SGOPF
Provider Second Line Business Practice Location Address:
RAF LAKENHEATH
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09464
Provider Business Practice Location Address Country Code:
GB
Provider Business Practice Location Address Telephone Number:
011441638528010
Provider Business Practice Location Address Fax Number:
011441638528022
Provider Enumeration Date:
09/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  02002228A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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