Provider Demographics
NPI:1265511943
Name:VAN SANTEN, LENORE (MD)
Entity Type:Individual
Prefix:MS
First Name:LENORE
Middle Name:
Last Name:VAN SANTEN
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 1:2025 W OKLAHOMA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216
Mailing Address - Country:US
Mailing Address - Phone:414-389-2790
Mailing Address - Fax:414-389-2791
Practice Address - Street 1:2025 W OKLAHOMA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216
Practice Address - Country:US
Practice Address - Phone:414-389-2790
Practice Address - Fax:414-649-5930
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30156000Medicaid
WIB57284Medicare UPIN
WI30156000Medicaid
WI1703Medicare PIN