Provider Demographics
NPI:1972524676
Name:LE, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:608-324-1000
Mailing Address - Fax:
Practice Address - Street 1:515 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094716207R00000X
WI31895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10879OtherDEAN HEALTH PLAN
WI31710300Medicaid
90002361OtherWEA INS
1000348OtherPHYSICIANS PLUS
345605861003OtherBC/BS
390808509OtherCIGNA
390808509AVOtherUNITY
P00132933OtherMEDICARE RAILROAD
31710300OtherHIRSP
345605861003OtherBC/BS MEDICARE SUPPLEMENT
390808509OtherCT GENERAL
390808509OtherWPS
K12319OtherMEDICARE
345605861003OtherCOMPCARE
390808509AEOtherUNITY
39080850912OtherUNITY