Provider Demographics
NPI:1124144217
Name:ESPINOSA, LEANDRO ARIEL (MD)
Entity type:Individual
Prefix:
First Name:LEANDRO
Middle Name:ARIEL
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 N 92ND ST
Mailing Address - Street 2:AMG IMAGING
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1613
Mailing Address - Country:US
Mailing Address - Phone:414-358-5437
Mailing Address - Fax:
Practice Address - Street 1:975 PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9201
Practice Address - Country:US
Practice Address - Phone:414-358-5437
Practice Address - Fax:414-358-5421
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI539132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100009041Medicaid
WIP00882934OtherRR MEDICARE
WIP00882934OtherRR MEDICARE