Individual
ROSEMARY E LEITCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11123 PARKVIEW PLAZA DR, SUITE 2, FORT WAYNE, IN 46845-1707
(260) 490-6261
(260) 490-6261
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01035629
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000686566
ANTHEM
IN
05
—
100138260
—
IN
05
—
3133880
—
OH
Enumeration date
04/24/2007
Last updated
03/23/2013
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