Healthcare Provider Details

I. General information

NPI: 1114261591
Provider Name (Legal Business Name): STACEY RAE LEJEUNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2012
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARK ST STE A
MADISON WI
53715-1830
US

IV. Provider business mailing address

152108 TANAGER LN
RIB MOUNTAIN WI
54401-6737
US

V. Phone/Fax

Practice location:
  • Phone: 608-260-2900
  • Fax: 608-260-2976
Mailing address:
  • Phone: 715-213-8193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036178016
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number4301502411
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number61552
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number70750
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: