Healthcare Provider Details

I. General information

NPI: 1023464930
Provider Name (Legal Business Name): LESLIE MANESS HARRIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESLIE DIANE MANESS M.D.

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-6820
  • Fax:
Mailing address:
  • Phone: 414-266-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036164036
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number63978
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number88091-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: