Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | IA | |
N | 111NI0900X | Internist | IA | |
N | 111NN1001X | Nutrition | IL | |
N | 111NX0800X | Chiropractor Orthopedic Specialist | IL |
NPI | 1275734808 |
---|---|
Provider Name | Dr. Michael R. Leasenby |
First Address | Moline, IL 61265-6402 |
Second Address | Moline, IL 61265-6402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |