Fagan, Leonard Simon

Fagan, Leonard Simon is an individual health care provider with primary practice located at 10222 74Th Street Suite 200, Kenosha WI 53142-6800. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is his primary health care specialty. Fagan, Leonard Simon can be contacted via phone (262) 697-9200.

Contact Information

Primary practice address
10222 74Th Street Suite 200 Kenosha WI 53142-6800
Phone: (262) 697-9200
Fax: (262) 697-9206
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 46372-020 Wisconsin
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 46372 Wisconsin
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X ME157114 Florida

Profile Details

NPI number 1104812171
LBN Legal business name Fagan, Leonard Simon
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 23rd, 2005
Last updated Oct 3rd, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104812171 NPPES
Wisconsin MEDICAID 34485700

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