Provider Demographics
NPI:1215949110
Name:SEMKIW, LEO B (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:B
Last Name:SEMKIW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3907
Mailing Address - Country:US
Mailing Address - Phone:408-371-5300
Mailing Address - Fax:408-371-6387
Practice Address - Street 1:2430 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3907
Practice Address - Country:US
Practice Address - Phone:408-371-5300
Practice Address - Fax:408-371-6387
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56561174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245247196OtherGROUP NPI NUMBER
CA030493774OtherTAX INDENTIFICATION NUMBER
CA1245247196OtherGROUP NPI NUMBER
CAE59270Medicare UPIN
CA00G565611Medicare ID - Type UnspecifiedINDIVIDUAL PROV NUMBER