Healthcare Provider Details

I. General information

NPI: 1194776971
Provider Name (Legal Business Name): LESLIE M GIMENEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE ALLERGY AND IMMUNOLOGY
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE ALLERGY AND IMMUNOLOGY
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-6840
  • Fax: 414-266-6437
Mailing address:
  • Phone: 414-266-6840
  • Fax: 414-266-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number39048
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: