Provider Demographics
NPI:1891052817
Name:FARLEY, LEAH F (MD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:F
Last Name:FARLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:F
Other - Last Name:HAGLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6809 122ND AVE # 1
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7335
Mailing Address - Country:US
Mailing Address - Phone:262-654-8633
Mailing Address - Fax:262-654-5467
Practice Address - Street 1:6809 122ND AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7335
Practice Address - Country:US
Practice Address - Phone:262-654-8633
Practice Address - Fax:262-654-5467
Is Sole Proprietor?:No
Enumeration Date:2012-04-15
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8781005-1205208000000X
WI67514-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics