Provider Demographics
NPI:1548622533
Name:LECKEY, BRUCE DANIEL JR (DO)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DANIEL
Last Name:LECKEY
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:801 YORK ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4630
Practice Address - Country:US
Practice Address - Phone:920-683-5278
Practice Address - Fax:920-686-9674
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2022-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI1675-321207ZP0102X, 207ZD0900X, 207ND0900X, 207ND0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology