Provider Demographics
NPI:1992774160
Name:LEONARD, THOMAS JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2763 MANITOWOC RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6633
Mailing Address - Country:US
Mailing Address - Phone:920-468-8288
Mailing Address - Fax:920-468-9887
Practice Address - Street 1:2763 MANITOWOC RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6633
Practice Address - Country:US
Practice Address - Phone:920-468-8288
Practice Address - Fax:920-468-9887
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25884-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30658900Medicaid
WIAL3161445OtherDEA #
WIB54539Medicare UPIN
WI30658900Medicaid