Provider Demographics
NPI:1922058205
Name:PAINOVICH, LEZLIE J (DO)
Entity Type:Individual
Prefix:
First Name:LEZLIE
Middle Name:J
Last Name:PAINOVICH
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 1:333 EAST CAMPUS MALL UHS UW-MADISON
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1381
Mailing Address - Country:US
Mailing Address - Phone:608-265-5600
Mailing Address - Fax:608-263-6884
Practice Address - Street 1:333 EAST CAMPUS MALL UHS UW-MADISON
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1381
Practice Address - Country:US
Practice Address - Phone:608-265-5600
Practice Address - Fax:608-263-6884
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47928-021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60390OtherDEAN HEALTH INSURANCE
WI2018769OtherPHYSICIANS PLUS
WI43519800Medicaid
WI43519800Medicaid
G39960Medicare UPIN
WI007654375Medicare PIN
WI60390OtherDEAN HEALTH INSURANCE