License holder summary

HEIDI LEAKE LODGE is a Medical Physician And Surgeon licensed to practice in Pennsylvania. The address on file for HEIDI LEAKE LODGE is GLENDALE AZ 85310. This medical practitioner license is not current. The license was granted 06/17/1991 and expired on 12/31/1994.

Department of State

Board of Medicine

HEIDI LEAKE LODGE
Medical Physician And Surgeon
License number
MD044554L
Date granted
06/17/1991
Date expires
12/31/1994
Class
Medical Physician And Surgeon
Status
Inactive
Address
GLENDALE AZ 85310
medicinepa.com
ID 37637909
LAST UPDATED 2024-05-03 08:40:32 UTC

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