Individual
MATTHEW SCOTT LEISZLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 ST LIAM HALL, NOTRE DAME, IN 46556-5693
(574) 631-7497
Mailing address
101 ST LIAM HALL, NOTRE DAME, IN 46556-5693
(574) 631-7497
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01074692A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92430813
—
CO
Enumeration date
03/26/2008
Last updated
04/20/2015
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