Provider Demographics
NPI:1780638114
Name:MORELAND OB-GYN ASSOCIATES S C
Entity Type:Organization
Organization Name:MORELAND OB-GYN ASSOCIATES S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEONHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-544-4411
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:311
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-544-4411
Mailing Address - Fax:262-650-3856
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:311
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-544-4411
Practice Address - Fax:262-650-3856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32653800Medicaid