Healthcare Provider Details

I. General information

NPI: 1477646859
Provider Name (Legal Business Name): LEI YAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N OAK AVE
MARSHFIELD WI
54449
US

IV. Provider business mailing address

1000 N OAK AVE
MARSHFIELD WI
54449-5777
US

V. Phone/Fax

Practice location:
  • Phone: 715-387-7179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01095537A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number42873
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: