Provider Demographics
NPI:1457485013
Name:CAYDE LESLIE, MAYUMI L (MD)
Entity Type:Individual
Prefix:
First Name:MAYUMI
Middle Name:L
Last Name:CAYDE LESLIE
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 1:916 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINNECONNE
Mailing Address - State:WI
Mailing Address - Zip Code:54986-9782
Mailing Address - Country:US
Mailing Address - Phone:920-582-1100
Mailing Address - Fax:
Practice Address - Street 1:916 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WINNECONNE
Practice Address - State:WI
Practice Address - Zip Code:54986-9782
Practice Address - Country:US
Practice Address - Phone:920-582-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI453000626Medicare PIN
WI710180709Medicare PIN