Provider Demographics
NPI:1568810364
Name:CORAGGIO LLC
Entity Type:Organization
Organization Name:CORAGGIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBESKIND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-915-2584
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54957-1050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1524 S COMMERCIAL ST STE 2N
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4999
Practice Address - Country:US
Practice Address - Phone:844-547-4343
Practice Address - Fax:888-806-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44592207R00000X, 208000000X, 2080B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity MedicineGroup - Multi-Specialty