Provider Demographics
NPI:1518033448
Name:LEONARD, MICHAEL MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MARTIN
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 1:404 LINDBERG
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501
Mailing Address - Country:US
Mailing Address - Phone:956-687-8488
Mailing Address - Fax:956-687-2540
Practice Address - Street 1:404 LINDBERG
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-687-8488
Practice Address - Fax:956-687-2540
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9728207Q00000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120631003Medicaid
TX000F49RMedicare ID - Type Unspecified
TX120631003Medicaid