Provider Demographics
NPI:1326229873
Name:LEONARD J PIANKO MD PA
Entity Type:Organization
Organization Name:LEONARD J PIANKO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PIANKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-932-2441
Mailing Address - Street 1:20305 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1512
Mailing Address - Country:US
Mailing Address - Phone:305-932-2441
Mailing Address - Fax:305-933-1749
Practice Address - Street 1:20305 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1512
Practice Address - Country:US
Practice Address - Phone:305-932-2441
Practice Address - Fax:305-933-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50446207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063634700Medicaid
FLK1889Medicare PIN
FL063634700Medicaid