Provider Demographics
NPI:1588073290
Name:DEITHLOFF, MICHELLE ELIZABETH LEONARD (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELIZABETH LEONARD
Last Name:DEITHLOFF
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:ELIZABETH
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 540610
Mailing Address - Street 2:
Mailing Address - City:N SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-0610
Mailing Address - Country:US
Mailing Address - Phone:801-505-0821
Mailing Address - Fax:
Practice Address - Street 1:404 BRUNN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1102
Practice Address - Country:US
Practice Address - Phone:505-395-9575
Practice Address - Fax:877-540-1253
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPOD401213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery