Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Leonard Simon Fagan, MD

Individual provider Specialist · NPI 1104812171

Dr. Leonard Simon Fagan, MD is a Specialist in Kenosha, Wisconsin. Licensed in Florida and Wisconsin. Registered with an NPI since 2005.

Licensed in
FL, WI
In the registry since
2005
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

10222 74th St Ste 200
Kenosha, WI 53142-6800
Phone: (262) 697-9200
Fax: (262) 697-9206
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Obstetrics & Gynecology Physician (primary) Taxonomy 207V00000X · Licence ME157114 (FL)
Specialist Taxonomy 174400000X · Licence 46372-020 (WI)
Obstetrics & Gynecology Physician Taxonomy 207V00000X · Licence 46372 (WI)

Record details

NPI number1104812171
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedSeptember 23, 2005
Last updated in NPPESOctober 3, 2022
Certification dateOctober 3, 2022

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