Leonidas Theodoro, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

30764 Issued in AZ

Practice address

9 Ladue Estates
Saint Louis, MO 63141

Phone

(314) 432-1805

NPI assigned

Mar 16, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Magellan Health Services of Arizona, Inc

  • Case Management Agency
  • Gilbert, AZ
  • NPI 1194965145
  NPD (past)
• Vo of Arizona, Inc.

  • Clinical Medical Laboratory
  • Glendale, AZ
  • NPI 1447458682
  NPD (past)
• Vo of Arizona, Inc.

  • Case Management Agency
  • Phoenix, AZ
  • NPI 1730139593
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502323200000",
    "number": "1366566408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 LADUE ESTATES",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63141",
            "telephone_number": "314-432-1805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 LADUE ESTATES",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63141",
            "telephone_number": "314-432-1805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODORO",
        "first_name": "LEONIDAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2017-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "R4130",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AZ",
            "license": "30764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nimita Thekkepat, PHARM D., MBA
• Elizabeth Ree Thele, M.S., OTR/L
• Danielle Thelen
• Mark William Thenhaus, DC
• Daniel L Theodoro, MD
• Panayotis Christos Theodoropoulos, MD, PHD
• Gus Theodos, M.D.
• Therapeutic and Diagnostic Imaging LLC
• Therapeutic Innovations LC
• Therapeutic Specialties Inc

• Psychiatry Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.