Healthcare Provider Details

I. General information

NPI: 1992124895
Provider Name (Legal Business Name): COURTNEY ANN LEMIEUX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY ANN SPOKE

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DELAFIELD STREET SUITE 311
WAUKESHA WI
53188
US

IV. Provider business mailing address

550 S JACKSON ST
LOUISVILLE KY
40202-1622
US

V. Phone/Fax

Practice location:
  • Phone: 262-544-4411
  • Fax: 262-650-3856
Mailing address:
  • Phone: 502-561-7448
  • Fax: 502-561-7480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR3541
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number69182-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: