Basic Information
| Provider Information | |||||||||
| NPI: | 1124144217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESPINOSA | ||||||||
| FirstName: | LEANDRO | ||||||||
| MiddleName: | ARIEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4025 N 92ND ST | ||||||||
| Address2: | AMG IMAGING | ||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532221613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143585437 | ||||||||
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| Practice Location | |||||||||
| Address1: | 975 PORT WASHINGTON RD | ||||||||
| Address2: | |||||||||
| City: | GRAFTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530249201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143585437 | ||||||||
| FaxNumber: | 4143585421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 53913 | WI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | P00882934 | 01 | WI | RR MEDICARE | OTHER |