MEDICARE: DR. LEONARD MENNEN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS0003135	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518916287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD MENNEN D.O.

Provider Business Mailing Address
First Line	:	2605 W SWANN AVE
Second Line	:	SUITE 600
City	:	TAMPA
State	:	FL
Zip	:	33609-4039
Country	:	US
Telephone Number	:	813-876-7073
Fax Number	:	813-877-1277

Provider Business Practice Location Address
First Line	:	2605 W SWANN AVE
Second Line	:	SUITE 600
City	:	TAMPA
State	:	FL
Zip	:	33609-4039
Country	:	US
Telephone Number	:	813-876-7073
Fax Number	:	813-877-1277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	02/04/2015

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