Provider Demographics
NPI:1447248539
Name:LEITNER, SUSAN AMY (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:AMY
Last Name:LEITNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:STE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:305-532-3378
Mailing Address - Fax:305-532-1164
Practice Address - Street 1:4308 ALTON RD
Practice Address - Street 2:SUITE 910
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4556
Practice Address - Country:US
Practice Address - Phone:305-532-3378
Practice Address - Fax:305-532-1164
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2016-05-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME68480208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378358800Medicaid
FL378358800Medicaid