Provider Demographics
NPI:1447294673
Name:MCNEALY, LEON B (MD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:B
Last Name:MCNEALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:
Practice Address - Street 1:1000 N OAK AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-5703
Practice Address - Country:US
Practice Address - Phone:715-387-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061165A2085R0001X
WI515932085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000479537OtherANTHEM PIN # / ARNETT
IN11537108OtherCAQH NUMBER
IN200822990Medicaid
WI35131700Medicaid
IN000000491798OtherANTHEM PIN # / OIGL
INAPPLYINGOtherPHCS PID NUMBER
IN815540PMedicare PIN
INP00338298Medicare PIN
WI35131700Medicaid
IN815450EEMedicare PIN