Provider Demographics
NPI:1245200427
Name:ALI, LAEEKHA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LAEEKHA
Middle Name:A
Last Name:ALI
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 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:
Practice Address - Street 1:707 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3027
Practice Address - Country:US
Practice Address - Phone:920-887-7181
Practice Address - Fax:920-887-6833
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28738207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32510400Medicaid
WIH32162Medicare UPIN
WI682300039Medicare PIN
WI32510400Medicaid
WI017600044Medicare PIN
WI132700004Medicare PIN
WIP00328559Medicare PIN
WI222950004Medicare PIN