Healthcare Provider Details

I. General information

NPI: 1063157212
Provider Name (Legal Business Name): LEESA MCGHEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W CLARKE ST
MILWAUKEE WI
53206-2030
US

IV. Provider business mailing address

1700 W CLARKE ST
MILWAUKEE WI
53206-2030
US

V. Phone/Fax

Practice location:
  • Phone: 414-460-9246
  • Fax:
Mailing address:
  • Phone: 414-460-9246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: