1922058205 NPI number — LEZLIE J PAINOVICH DO

Table of content: LEZLIE J PAINOVICH DO (NPI 1922058205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922058205 NPI number — LEZLIE J PAINOVICH DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAINOVICH
Provider First Name:
LEZLIE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922058205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 EAST CAMPUS MALL UHS UW-MADISON
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53715-1381
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-265-5600
Provider Business Mailing Address Fax Number:
608-263-6884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 EAST CAMPUS MALL UHS UW-MADISON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53715-1381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-265-5600
Provider Business Practice Location Address Fax Number:
608-263-6884
Provider Enumeration Date:
05/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  47928-021 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 60390 . This is a "DEAN HEALTH INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 2018769 . This is a "PHYSICIANS PLUS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 43519800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".