Provider Demographics
NPI:1023153947
Name:LEILANE U STA ROMANA MDSC
Entity type:Organization
Organization Name:LEILANE U STA ROMANA MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEILANE
Authorized Official - Middle Name:U
Authorized Official - Last Name:STA ROMANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-658-3706
Mailing Address - Street 1:3734 7TH AVE
Mailing Address - Street 2:DOMINICAN BUILDING SUITE 15
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-5525
Mailing Address - Country:US
Mailing Address - Phone:262-658-3706
Mailing Address - Fax:
Practice Address - Street 1:3734 7TH AVE
Practice Address - Street 2:DOMINICAN BUILDING SUITE 15
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-5525
Practice Address - Country:US
Practice Address - Phone:262-658-3706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty