Provider Demographics
NPI:1063561801
Name:LEIMAN, LORI JILL (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JILL
Last Name:LEIMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-389-7000
Mailing Address - Fax:954-389-8726
Practice Address - Street 1:1835 N CORPORATE LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3211
Practice Address - Country:US
Practice Address - Phone:954-389-7000
Practice Address - Fax:954-272-0819
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 71102208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252889400Medicaid
FL252889400Medicaid