Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 51718-020 | WI |
NPI | 1053357384 |
---|---|
Provider Name | Lisa M. Lepeak |
First Address | Madison, WI 53717-1959 |
Second Address | Madison, WI 53717-1959 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 08/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053357384 | (05) | WI |