Individual
LELAND J FROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1969 W HART RD, BELOIT, WI 53511-2230
(608) 363-5985
(608) 364-5452
Mailing address
1969 W HART RD, BELOIT, WI 53511-2230
(608) 363-5985
(608) 364-5452
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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