Provider Demographics
NPI:1457538274
Name:LEDESMA, WENDY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:MARIE
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:MARIE
Other - Last Name:DINGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 26TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2203
Mailing Address - Country:US
Mailing Address - Phone:608-643-3311
Mailing Address - Fax:608-643-8600
Practice Address - Street 1:260 26TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-2203
Practice Address - Country:US
Practice Address - Phone:608-643-3311
Practice Address - Fax:608-643-8600
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
WI51254-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1457538274Medicaid
WI1457538274Medicaid