Healthcare Provider Details

I. General information

NPI: 1376160366
Provider Name (Legal Business Name): LENG XIONG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 N GRANDVIEW BLVD STE 300
PEWAUKEE WI
53072-5591
US

IV. Provider business mailing address

2835 N GRANDVIEW BLVD STE 300
PEWAUKEE WI
53072-5591
US

V. Phone/Fax

Practice location:
  • Phone: 262-542-3779
  • Fax: 262-542-3355
Mailing address:
  • Phone: 262-542-3779
  • Fax: 262-542-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC007123
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1318-25
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: