Provider Demographics
NPI:1194780098
Name:LEIGH, DAVID HANSON I (ATC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:HANSON
Last Name:LEIGH
Suffix:I
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N84W14792 MENOMONEE AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3229
Mailing Address - Country:US
Mailing Address - Phone:262-255-4173
Mailing Address - Fax:
Practice Address - Street 1:1532 W CLYBOURN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2202
Practice Address - Country:US
Practice Address - Phone:414-288-6078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI247-039173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine