Provider Demographics
NPI:1497718027
Name:MENA, LEANDRO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANDRO
Middle Name:ANTONIO
Last Name:MENA
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 1:2500 NORTH STATE STREET
Mailing Address - Street 2:DIVISION INFECTIOUS DISEASES
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-984-5560
Mailing Address - Fax:601-815-4014
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DIVISION INFECTIOUS DISEASES
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5560
Practice Address - Fax:601-815-4014
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13129207P00000X
MS17860207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01245275OtherRAILROAD PTAN
MS08920791Medicaid
LA1576107Medicaid
MSP00755097Medicare PIN
MS302I448640Medicare PIN
LA1576107Medicaid
MS08920791Medicaid
MS440000026Medicare PIN