Provider Demographics
NPI:1669904900
Name:HELLER, LEA (MD)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
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:SCHROEDER COMPLEX, LOWER LEVEL
Mailing Address - Street 2:540 N 16TH STREET
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233
Mailing Address - Country:US
Mailing Address - Phone:414-288-7184
Mailing Address - Fax:
Practice Address - Street 1:540 N 16TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2160
Practice Address - Country:US
Practice Address - Phone:414-288-7184
Practice Address - Fax:414-288-1664
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI83445-20207Q00000X, 207Q00000X
WAMD60958070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine