Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 007473 | IA |
Y | 213ER0200X | Radiology | 007473 | IA |
N | 111NR0200X | Radiology | 038.012224 | IL |
N | 213ER0200X | Radiology | 038.012224 | IL |
NPI | 1669905238 |
---|---|
Provider Name | Siri Leech |
First Address | Davenport, IA 52803-5214 |
Second Address | Davenport, IA 52803-5214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2017 |
Last Update Date | 10/04/2017 |