Provider Demographics
NPI:1215345202
Name:WONDER KIDS PEDIATRICS, PLLC
Entity type:Organization
Organization Name:WONDER KIDS PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEILOGLOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-392-3506
Mailing Address - Street 1:18815 MILLHOLLOW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4258
Mailing Address - Country:US
Mailing Address - Phone:210-392-3506
Mailing Address - Fax:
Practice Address - Street 1:20818 GATHERING OAK
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-3104
Practice Address - Country:US
Practice Address - Phone:210-762-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2984208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty