Provider Demographics
NPI:1245872761
Name:LEGATE, STEVEN FREDERICK (PHYSICIAN ASSISTANT)
Entity type:Individual
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First Name:STEVEN
Middle Name:FREDERICK
Last Name:LEGATE
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:705 VILLAGE GREEN WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:920-351-4530
Mailing Address - Fax:978-620-2348
Practice Address - Street 1:705 VILLAGE GREEN WAY STE 101
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-7280
Practice Address - Country:US
Practice Address - Phone:920-351-4530
Practice Address - Fax:978-620-2348
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2024-05-23
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Provider Licenses
StateLicense IDTaxonomies
WI7309-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant