Provider Demographics
NPI:1053719302
Name:WINCE, LELAND LAMAR (MD)
Entity type:Individual
Prefix:MR
First Name:LELAND
Middle Name:LAMAR
Last Name:WINCE
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 1:8040 E. CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47320
Mailing Address - Country:US
Mailing Address - Phone:765-288-3072
Mailing Address - Fax:
Practice Address - Street 1:8040 EAST CLIFTON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47320
Practice Address - Country:US
Practice Address - Phone:765-288-3072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01020366A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics