Basic Information
| Provider Information | |||||||||
| NPI: | 1629066469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEINING | ||||||||
| FirstName: | MAIRI | ||||||||
| MiddleName: | GAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27128 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841270128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356587000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 ROUND VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840607552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356587000 | ||||||||
| FaxNumber: | 5305418723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A92496 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 7744218-1205 | UT | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 00A924960 | 05 | CA | MEDICAID | 100510444 | 05 | NV | MEDICAID |