Provider Demographics
NPI:1114261591
Name:LEJEUNE, STACEY RAE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:RAE
Last Name:LEJEUNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 PINE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7803
Mailing Address - Country:US
Mailing Address - Phone:715-847-2022
Mailing Address - Fax:
Practice Address - Street 1:2400 PINE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7803
Practice Address - Country:US
Practice Address - Phone:715-847-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-25
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI707502086S0129X
MI43015024112086S0129X
MN615522086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty