Provider Demographics
NPI:1558307157
Name:MICHL, LEON G (MD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:G
Last Name:MICHL
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 1:1801 CLIFTY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-1627
Mailing Address - Country:US
Mailing Address - Phone:812-265-6800
Mailing Address - Fax:812-265-1470
Practice Address - Street 1:1801 CLIFTY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1627
Practice Address - Country:US
Practice Address - Phone:812-265-6800
Practice Address - Fax:812-265-1470
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022267208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN410017POtherSIHO
IN000000042198OtherANTHEM BCBS
020041435OtherMEDICARE RAILROAD
IN100047820AMedicaid
KY1073889OtherPASSPORT KY MEDICAID
KY2435127000OtherPASSPORT ADVANTAGE
4370917OtherAETNA
KY64349947Medicaid
IN100047820AMedicaid
D67781Medicare UPIN
IN412840KMedicare ID - Type Unspecified
IN412840KMedicare PIN