Healthcare Provider Details

I. General information

NPI: 1104893312
Provider Name (Legal Business Name): ROBERT F LEMANSKE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 SUNSET DR
MADISON WI
53705-1430
US

IV. Provider business mailing address

3515 SUNSET DR
MADISON WI
53705-1430
US

V. Phone/Fax

Practice location:
  • Phone: 608-233-3246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number20150
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: