Provider Demographics
NPI:1558804526
Name:LEONARDO MONTEMURRO SERVICE CORPORATION
Entity Type:Organization
Organization Name:LEONARDO MONTEMURRO SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:D
Authorized Official - Last Name:MONTEMURRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-945-7557
Mailing Address - Street 1:9555 76TH ST
Mailing Address - Street 2:STE 2601
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53158-1984
Mailing Address - Country:US
Mailing Address - Phone:262-945-7557
Mailing Address - Fax:262-577-8476
Practice Address - Street 1:9555 76TH ST
Practice Address - Street 2:STE 2601
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53158-1984
Practice Address - Country:US
Practice Address - Phone:262-945-7557
Practice Address - Fax:262-577-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK100356816Medicare PIN