Healthcare Provider Details

I. General information

NPI: 1164798393
Provider Name (Legal Business Name): JOHN MATTHEW LESCHKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 S MADISON ST UNIT 110
APPLETON WI
54915-1844
US

IV. Provider business mailing address

4764 W INTEGRITY WAY # 175
APPLETON WI
54913-8464
US

V. Phone/Fax

Practice location:
  • Phone: 920-939-7868
  • Fax: 920-939-7869
Mailing address:
  • Phone: 920-939-7868
  • Fax: 920-939-7869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number01099969A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number61977-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: