Provider Demographics
NPI:1902810831
Name:LEEDY, ALICIA (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:LEEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11911 N MERIDIAN ST
Practice Address - Street 2:SUITE 180
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6904
Practice Address - Country:US
Practice Address - Phone:317-621-6888
Practice Address - Fax:317-621-6886
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01047074A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200240200Medicaid
IN000000319536OtherANTHEM
IN200240200Medicaid
INM400040677Medicare PIN