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Individual

DR. LEESA DAMAR MCCAULEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2400 17TH ST, COLUMBUS, IN 47201-5351
(812) 376-5974
(812) 375-3203
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01074422A
IN
207Q00000X
Family Medicine Physician
57-012612
OH
208M00000X
Hospitalist Physician
Primary
01074422A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000984086
ANTHEM PIN
IN
01
01074422A
MEDICAL LICENSE
IN
01
01074422B
CSR
IN
05
201248300A
IN
05
2997155
OH
Enumeration date
05/24/2007
Last updated
09/06/2024
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