Healthcare Provider Details

I. General information

NPI: 1558399279
Provider Name (Legal Business Name): WILLIAM C LEACH JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 YORK ST
MANITOWOC WI
54220-6825
US

IV. Provider business mailing address

600 YORK ST
MANITOWOC WI
54220-6825
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-8742
  • Fax: 920-320-8775
Mailing address:
  • Phone: 920-320-8742
  • Fax: 920-320-8775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number46781
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: