Provider Demographics
NPI:1811139413
Name:LEI, LEI (MD)
Entity type:Individual
Prefix:
First Name:LEI
Middle Name:
Last Name:LEI
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 1:10625 W NORTH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2315
Mailing Address - Country:US
Mailing Address - Phone:414-877-5351
Mailing Address - Fax:414-877-5361
Practice Address - Street 1:10625 W NORTH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2315
Practice Address - Country:US
Practice Address - Phone:414-877-5351
Practice Address - Fax:414-877-5361
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56922207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine