Individual
DANNY LYNN LEATHERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
714 N SENATE AVE, STE 100, INDIANAPOLIS, IN 46202-3763
(317) 715-6381
(317) 472-4566
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01057770
IN
2085R0202X
Diagnostic Radiology Physician
35525
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1506086
—
TN
05
—
201010540
—
IN
01
—
4141784
BCBS PROVIDER NUMBER
TN
01
—
620864298
TRICARE
—
01
—
P00860880
RAILROAD MEDICARE
IN
Enumeration date
08/31/2006
Last updated
02/18/2021
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