Provider Demographics
NPI:1598296212
Name:RABAUT, LESLIE J (DO)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:J
Last Name:RABAUT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W KK RIVER PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3678
Mailing Address - Country:US
Mailing Address - Phone:414-649-7909
Mailing Address - Fax:
Practice Address - Street 1:2801 W KK RIVER PKWY STE 250
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3678
Practice Address - Country:US
Practice Address - Phone:414-649-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70808-21207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine