Provider Demographics
NPI:1750305090
Name:LEONETTI, WILLIAM J (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:LEONETTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3201 W PEORIA AVE
Mailing Address - Street 2:SUITE A200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4608
Mailing Address - Country:US
Mailing Address - Phone:602-843-3277
Mailing Address - Fax:602-843-3643
Practice Address - Street 1:3201 W PEORIA AVE
Practice Address - Street 2:SUITE A200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4608
Practice Address - Country:US
Practice Address - Phone:602-843-3277
Practice Address - Fax:602-843-3643
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ210213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ188715900OtherACS NUMBER
AZ480025917OtherRAILROAD MEDICARE
AZ6819144OtherCIGNA NUMBER
AZ630556OtherAETNA NUMBER
AZAZ0068970OtherBCBS NUMBER
AZ1047610002Medicare NSC
AZZWCGCLMedicare ID - Type UnspecifiedMEDICARE #
AZT88241Medicare UPIN