Provider Demographics
NPI:1073582490
Name:LEECH, RICHARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:LEECH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:721 AMERICAN AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-549-1516
Mailing Address - Fax:262-549-0648
Practice Address - Street 1:721 AMERICAN AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-549-1516
Practice Address - Fax:262-549-0648
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI27471207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30772400Medicaid
WIB54510Medicare UPIN