Provider Demographics
NPI:1689620072
Name:MONTEMURRO, LEONARDO SR (MD)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:MONTEMURRO
Suffix:SR
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 1:6121 GREEN BAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2931
Mailing Address - Country:US
Mailing Address - Phone:262-945-7557
Mailing Address - Fax:262-727-0841
Practice Address - Street 1:6121 GREEN BAY RD STE 100
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2931
Practice Address - Country:US
Practice Address - Phone:262-945-7557
Practice Address - Fax:262-727-0841
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32501700Medicaid
390007566OtherMEDICARE RAILROAD
390007566OtherMEDICARE RAILROAD
WI32501700Medicaid