MEDICARE: LEONARD B SMITH

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	172A00000X	Driver	S530-5225-5446-04	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DRR 0018977	OTHER	WI	PUBLIC PASSENGER LICENSE

General Provider Information

NPI Number	:	1740499854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD B SMITH

Provider Business Mailing Address
First Line	:	3933 N 76TH ST APT 4
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-3049
Country	:	US
Telephone Number	:	414-479-9400
Fax Number	:	414-259-1663

Provider Business Practice Location Address
First Line	:	1000 N 92ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-3533
Country	:	US
Telephone Number	:	414-479-9400
Fax Number	:	414-259-1663

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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Directions to “ LEONARD B SMITH ” Practice Location

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