| Leistikowmd Llc | |
|
600 Wyndhurst Ave Ste 305e Baltimore MD 21210-2489 | |
| (443) 459-1840 | |
| Not Available |
| Full Name | Leistikowmd Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 600 Wyndhurst Ave Ste 305e, Baltimore, Maryland |
| Authorized Official Name and Position | Nicole Leistikow (OWNER) |
| Authorized Official Contact | 4437999384 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leistikowmd Llc 600 Wyndhurst Ave Ste 305e Baltimore MD 21210-2489 Ph: (443) 799-9384 | Leistikowmd Llc 600 Wyndhurst Ave Ste 305e Baltimore MD 21210-2489 Ph: (443) 459-1840 |
| NPI Number | 1285213843 |
|---|---|
| Provider Enumeration Date | 04/02/2021 |
| Last Update Date | 02/08/2022 |
| Certification Date | 02/08/2022 |
| Medicare PECOS PAC ID | 5193134229 |
|---|---|
| Medicare Enrollment ID | O20210503000099 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285213843 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Nicole Leistikow |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861784118 PECOS PAC ID: 8123264991 Enrollment ID: I20170626001602 |
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