Provider Demographics
NPI:1093743452
Name:LEIGHTON, MICAELA J (MD)
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:J
Last Name:LEIGHTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICAELA
Other - Middle Name:
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2145 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1503
Mailing Address - Country:US
Mailing Address - Phone:888-705-8558
Mailing Address - Fax:
Practice Address - Street 1:1100 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-1572
Practice Address - Country:US
Practice Address - Phone:913-297-9628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ875411Medicaid
AZ875411Medicaid