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General NPI Number Information
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NPI Number | 1992966493
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Entity Type | Individual
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Provider Name | DOMINIC THEODORE GOMEZ LEONARDELLI MD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 225000 HUMMINGBIRD RD STE 100
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City | WAUSAU
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State | WI
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Zip | 54401-2950
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Country | US
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Telephone | 715-359-6442
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Fax |
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Provider Business Mailing Address
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Address Line | 2924 NIGHT WATCH WAY
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City | ALPINE
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State | CA
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Zip | 91901-4115
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Country | US
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Telephone | 719-671-9277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 55350
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 53408-20
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 53408-20
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License Number State | WI
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