Healthcare Provider Details

I. General information

NPI: 1609844174
Provider Name (Legal Business Name): JEFFREY S SLEETH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S PARK ST
MADISON WI
53715
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-287-2580
  • Fax: 608-287-2340
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31390
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: