Active NPI
Milton Leganchuk, LAT
- Athletic Trainer
- Manitowoc, WI
National Provider Identifier
1407917883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 680-039
- Practice address
- 2719 Calumet Ave
Manitowoc, WI 54220-5546 - Phone
- (920) 683-1900
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 680-039 | WI | Primary |
Addresses
Primary practice location
2719 Calumet Ave
Manitowoc, WI 54220-5546
Mailing address
1016 N Wisconsin Dr
Howards Grove, WI 53083-1043
Phone (920) 207-0481
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 680-039 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257206400000",
"number": "1407917883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1016 N WISCONSIN DR",
"city": "HOWARDS GROVE",
"state": "WI",
"postal_code": "530831043",
"telephone_number": "920-207-0481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2719 CALUMET AVE",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542205546",
"telephone_number": "920-683-1900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEGANCHUK",
"first_name": "MILTON",
"credential": "LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2009-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "680-039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manitowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.