Basic Information
| Provider Information | |||||||||
| NPI: | 1215161187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEATHERS | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | ANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 702 BARNHILL DR RM 5867 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462025128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172780003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6940 MICHIGAN RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462682800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172662901 | ||||||||
| FaxNumber: | 3172662916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2009 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 01069865A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.