Provider Demographics
NPI:1598833006
Name:LEIB, MELISSA LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LOUISE
Last Name:LEIB
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 1:1110 E OGDEN AVE
Mailing Address - Street 2:#318
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2934
Mailing Address - Country:US
Mailing Address - Phone:608-698-9676
Mailing Address - Fax:
Practice Address - Street 1:1110 E OGDEN AVE
Practice Address - Street 2:#318
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2934
Practice Address - Country:US
Practice Address - Phone:608-698-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51497-20207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine