Provider Demographics
NPI:1457342255
Name:KENZAKOWSKI, LEO F (MD)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:F
Last Name:KENZAKOWSKI
Suffix:
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 1:4050 INNSLAKE DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3327
Mailing Address - Country:US
Mailing Address - Phone:804-521-5315
Mailing Address - Fax:804-521-5312
Practice Address - Street 1:1602 SKIPWITH RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5205
Practice Address - Country:US
Practice Address - Phone:804-289-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233641207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6230121OtherCIGNA
VA10228905Medicaid
VA1457342255Medicaid
VA302011OtherANTHEM
VAP00601102OtherMEDICARE RAILROAD
VA10228905OtherANTHEM
VAP00606712OtherRR MEDICARE
VA631615OtherSOUTHERN HEALTH
VA631615OtherSOUTHERN HEALTH
VA10228905Medicaid
VA00X510C01Medicare PIN