MEDICARE: DR. MICHAEL J LEONETTI D. P. M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	16-2996	IL
2	213ES0103X	Foot & Ankle Surgery Podiatrist	229	AZ

General Provider Information

NPI Number	:	1649246620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J LEONETTI D. P. M.

Provider Business Mailing Address
First Line	:	9042 31ST ST
Second Line	:
City	:	BROOKFIELD
State	:	IL
Zip	:	60513-1347
Country	:	US
Telephone Number	:	708-485-9300
Fax Number	:	708-354-2822

Provider Business Practice Location Address
First Line	:	9042 31ST ST
Second Line	:
City	:	BROOKFIELD
State	:	IL
Zip	:	60513-1347
Country	:	US
Telephone Number	:	708-485-9300
Fax Number	:	708-354-2822

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	02/21/2013

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