Healthcare Provider Details

I. General information

NPI: 1053357384
Provider Name (Legal Business Name): LISA M. LEPEAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/21/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 FISH HATCHERY RD.
MADISON WI
53715-1909
US

IV. Provider business mailing address

1211 FISH HATCHERY RD.
MADISON WI
53715-1909
US

V. Phone/Fax

Practice location:
  • Phone: 608-252-8000
  • Fax: 608-410-2905
Mailing address:
  • Phone: 608-252-8000
  • Fax: 608-410-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number51718-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: