Provider Demographics
NPI:1558399279
Name:LEACH, WILLIAM C JR (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:LEACH
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:600 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-6825
Mailing Address - Country:US
Mailing Address - Phone:920-320-8742
Mailing Address - Fax:920-320-8775
Practice Address - Street 1:600 YORK ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6825
Practice Address - Country:US
Practice Address - Phone:920-320-8742
Practice Address - Fax:920-320-8775
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46781207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI68015-0067Medicare PIN
WI02120-0239Medicare PIN