Healthcare Provider Details

I. General information

NPI: 1568810364
Provider Name (Legal Business Name): CORAGGIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 10/01/2023
Certification Date: 10/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 S COMMERCIAL ST STE 2N
NEENAH WI
54956-4999
US

IV. Provider business mailing address

PO BOX 1050
NEENAH WI
54957-1050
US

V. Phone/Fax

Practice location:
  • Phone: 844-547-4343
  • Fax: 888-806-8148
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44592
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44592
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number44592
License Number StateWI

VIII. Authorized Official

Name: ANN LIEBESKIND
Title or Position: OWNER
Credential: MD
Phone: 920-915-2584