Provider Demographics
NPI:1487820932
Name:SURBECK, LESLIE WINTER (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:WINTER
Last Name:SURBECK
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 1:405 STAGELINE RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7848
Mailing Address - Country:US
Mailing Address - Phone:715-531-6700
Mailing Address - Fax:715-531-6726
Practice Address - Street 1:405 STAGELINE RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-7848
Practice Address - Country:US
Practice Address - Phone:715-531-6700
Practice Address - Fax:715-531-6726
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI55355-020207R00000X
MN50990207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program