Individual
KIM LEATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1344 WINTERGREEN LN NE, BAINBRIDGE ISLAND, WA 98110
(206) 842-5632
(206) 842-5992
Mailing address
1344 WINTERGREEN LN NE, BAINBRIDGE ISLAND, WA 98110-5118
(206) 842-5632
(206) 842-5992
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00027650
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039581
LABOR & INDUSTRY
WA
05
—
1067594
—
WA
01
—
LE3004
BLUE SHIELD
WA
01
—
US0899742
AETNA/USHC PCP
WA
Enumeration date
08/31/2006
Last updated
06/13/2018
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