Individual
FREDERICK E LEICKLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2665 FOX POINTE DR, COLUMBUS, IN 47203-3222
(812) 378-3131
(812) 379-9251
Mailing address
DEPT. 453 PO BOX 1000, MEMPHIS, TN 38148-0001
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
01042436A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100379150
—
IN
01
—
IN1125015
MEDICARE PTAN
IN
Enumeration date
08/30/2006
Last updated
05/03/2022
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