Healthcare Provider Details

I. General information

NPI: 1922058205
Provider Name (Legal Business Name): LEZLIE J PAINOVICH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EAST CAMPUS MALL UHS UW-MADISON
MADISON WI
53715-1381
US

IV. Provider business mailing address

333 EAST CAMPUS MALL UHS UW-MADISON
MADISON WI
53715-1381
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-5600
  • Fax: 608-263-6884
Mailing address:
  • Phone: 608-265-5600
  • Fax: 608-263-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47928-021
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: