Healthcare Provider Details

I. General information

NPI: 1679917900
Provider Name (Legal Business Name): ROBERT RYAN LEAHY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: R. RYAN LEAHY M.D.

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20225 WATER TOWER BLVD STE 300
BROOKFIELD WI
53045-3597
US

IV. Provider business mailing address

20225 WATER TOWER BLVD STE 300
BROOKFIELD WI
53045-3597
US

V. Phone/Fax

Practice location:
  • Phone: 262-500-4324
  • Fax: 262-226-9108
Mailing address:
  • Phone: 262-500-4324
  • Fax: 262-269-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number1411
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1411
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number1411
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number1411
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: