Basic Information
| Provider Information | |||||||||
| NPI: | 1831586312 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEEWARD MEDICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 BLUE GULF DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324594585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122124865 | ||||||||
| FaxNumber: | 8508554045 | ||||||||
| Practice Location | |||||||||
| Address1: | 4554 E HIGHWAY 20 | ||||||||
| Address2: | |||||||||
| City: | NICEVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325789755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122124865 | ||||||||
| FaxNumber: | 8508554045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2015 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | HANDWERKER | ||||||||
| AuthorizedOfficialFirstName: | KASEY | ||||||||
| AuthorizedOfficialMiddleName: | NICOLE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8502152337 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RP1001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207RG0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 213E00000X | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 175L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Homeopath | 207P00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.