=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326285354
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEONARD ARTHUR WISNESKI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2009
-----------------------------------------------------
Last Update Date | 01/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31541 PIKE VIEW DR
-----------------------------------------------------
City | CONIFER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80433-7536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-838-7331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31541 PIKE VIEW DR
-----------------------------------------------------
City | CONIFER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80433-7536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-838-7331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 47329
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | D0019393
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------