Matthew Scott Leiszler
Individual provider Active NPI Family Medicine Physician · Notre Dame, IN
NPI 1386816692 · NPPES record last updated Apr 20, 2015
Key facts
- NPI
- 1386816692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 01074692A (IN)
- Practice address
- 101 St Liam Hall
Notre Dame, IN 46556-5693 - Phone
- (574) 631-7497
- NPI assigned
- Mar 26, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01074692A | IN | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01074692A | IN | Yes |
Addresses
Primary practice location
101 St Liam Hall
Notre Dame, IN 46556-5693
Mailing address
101 St Liam Hall
Notre Dame, IN 46556-5693
Phone (574) 631-7497
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 92430813 | Medicaid | CO |
Other providers in Notre Dame, IN
- Sofia Santiaguel Ignaco
- Patricia Ann Kelly-Holmes
- Cloe Lucia Klaus
- Labcorp Indiana Inc
- Laboratory Corporation of America Holdings
- Janet Lovett
- Anne M Marquez
- Anne Therese Martin
- Courtney McNamara
- James Michael Moriarity
All providers in Notre Dame, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.