Basic Information
| Provider Information | |||||||||
| NPI: | 1821034604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEIMKUEHLER | ||||||||
| FirstName: | MELISSA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 W 10TH ST APT 202 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641051896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164040751 | ||||||||
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| Practice Location | |||||||||
| Address1: | TMC - 2301 HOLMES ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164040751 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 2005013756 | MO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 204517700 | 05 | MO | MEDICAID | 407875600 | 05 | MD | MEDICAID |