Provider Demographics
NPI:1609833383
Name:GO, LEONARD L (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:L
Last Name:GO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:700 S PARK ST
Mailing Address - Street 2:DEAN ST. MARY'S OUTPATIENT CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1830
Mailing Address - Country:US
Mailing Address - Phone:608-260-2900
Mailing Address - Fax:608-260-2976
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:DEAN ST. MARY'S OUTPATIENT CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-260-2900
Practice Address - Fax:608-260-2976
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2010-03-02
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI32290-020208600000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32435700Medicaid
WI6314OtherDEAN HEALTH INSURANCE
WI6314OtherDEAN HEALTH INSURANCE
WI32435700Medicaid