Healthcare Provider Details

I. General information

NPI: 1427443753
Provider Name (Legal Business Name): DYLAN STEVEN LEDFORD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 COUNTY RD N
COTTAGE GROVE WI
53527-9208
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-839-3104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number66688
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: