Individual
LELAND J FROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
23638020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10638
DEAN HEALTH PLAN HMO
—
05
—
30396900
—
WI
Enumeration date
08/07/2006
Last updated
01/03/2009
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