Healthcare Provider Details

I. General information

NPI: 1053389122
Provider Name (Legal Business Name): LESLEY A COERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 TOEPFER AVE
MADISON WI
53711-1666
US

IV. Provider business mailing address

572 TOEPFER AVE
MADISON WI
53711-1666
US

V. Phone/Fax

Practice location:
  • Phone: 608-358-2917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47820
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: