Provider Demographics
NPI:1407198112
Name:MOGELVANG, LEONARD PC (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:PC
Last Name:MOGELVANG
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:P.O. BOX 3316
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34106-3316
Mailing Address - Country:US
Mailing Address - Phone:239-450-9820
Mailing Address - Fax:239-643-6803
Practice Address - Street 1:2150 NORTH ROAD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-4381
Practice Address - Country:US
Practice Address - Phone:239-450-9820
Practice Address - Fax:239-643-6803
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME13023208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery