Provider Demographics
NPI:1558422634
Name:TAYLOR, LESLIE V (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:V
Last Name:TAYLOR
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 1:2711 ALLEN BLVD
Mailing Address - Street 2:DEAN MEDICAL FOUNDATION
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2287
Mailing Address - Country:US
Mailing Address - Phone:608-827-2300
Mailing Address - Fax:608-827-2399
Practice Address - Street 1:2711 ALLEN BLVD
Practice Address - Street 2:DEAN MEDICAL FOUNDATION
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2287
Practice Address - Country:US
Practice Address - Phone:608-827-2300
Practice Address - Fax:608-827-2399
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30510-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31777300Medicaid
F76094Medicare UPIN
WI039074150Medicare PIN
WI260044765Medicare PIN