Individual
MR. JERALD W LEISY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D. P.A.
Contact information
Practice address
3310 EAST DOUGLAS AVE #101, WICHITA, KS 67208
(316) 681-2937
(316) 681-1262
Mailing address
3310 EAST DOUGLAS AVE # 101, WICHITA, KS 67208
(316) 681-2937
(316) 681-1262
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
14574
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100164140A
—
KS
Enumeration date
11/14/2006
Last updated
04/04/2012
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