Individual
KENNETH H LEESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 HADDON AVE, WOUND CARE, CAMDEN, NJ 08103-3101
(856) 546-3900
(856) 546-3908
Mailing address
500 GROVE ST, SUITE 100, HADDON HEIGHTS, NJ 08035-1761
(856) 796-9200
(856) 796-7397
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
25MA02077500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3034003
—
NJ
Enumeration date
07/16/2006
Last updated
01/12/2015
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