Provider Demographics
NPI:1386653772
Name:LEININGER, KIRK W (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:W
Last Name:LEININGER
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-357-8818
Mailing Address - Fax:801-357-8817
Practice Address - Street 1:1055 N 300 W
Practice Address - Street 2:#410
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3344
Practice Address - Country:US
Practice Address - Phone:801-357-8818
Practice Address - Fax:801-357-8817
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5405900-1205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000060886Medicare PIN
UTH43787Medicare UPIN
UT000063378Medicare PIN
UT000063378Medicare PIN