Provider Demographics
NPI:1902071848
Name:MARCUM, LESLIE CATHERINE (NMD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:CATHERINE
Last Name:MARCUM
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 E SHEA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6086
Mailing Address - Country:US
Mailing Address - Phone:602-283-2061
Mailing Address - Fax:
Practice Address - Street 1:4740 E SHEA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6086
Practice Address - Country:US
Practice Address - Phone:602-283-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine