Healthcare Provider Details

I. General information

NPI: 1538939640
Provider Name (Legal Business Name): LECHE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 N 35TH ST
MILWAUKEE WI
53210-1923
US

IV. Provider business mailing address

3025 N 35TH ST
MILWAUKEE WI
53210-1923
US

V. Phone/Fax

Practice location:
  • Phone: 414-858-6855
  • Fax:
Mailing address:
  • Phone: 414-788-5947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number84169-82
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: