Provider Demographics
NPI:1346223278
Name:LEONARD, STEPHEN RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RAYMOND
Last Name:LEONARD
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 1:440 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-4631
Mailing Address - Country:US
Mailing Address - Phone:906-775-9040
Mailing Address - Fax:906-774-7279
Practice Address - Street 1:440 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4631
Practice Address - Country:US
Practice Address - Phone:906-775-9040
Practice Address - Fax:906-774-7279
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI022-94916-113Medicare ID - Type Unspecified
P00616801Medicare Oscar/Certification
MIOP38340002Medicare Oscar/Certification
WI000002Medicare Oscar/Certification