Provider Demographics
NPI:1912910282
Name:WINER, LEONARD D (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:D
Last Name:WINER
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 1:3015 N BALLAS RD
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2329
Mailing Address - Country:US
Mailing Address - Phone:314-996-5363
Mailing Address - Fax:314-996-4944
Practice Address - Street 1:3015 N BALLAS RD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2329
Practice Address - Country:US
Practice Address - Phone:314-996-5363
Practice Address - Fax:314-996-4944
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014412207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
020841Medicare ID - Type Unspecified
B34345Medicare UPIN
P00254251Medicare PIN