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General NPI Number Information
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NPI Number | 1588870554
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Entity Type | Individual
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Provider Name | JORGE ENRIQUE LEON COLONNA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 8701 WATERTOWN PLANK RD ATTN. CHAD LIPTOW, MS
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City | MILWAUKEE
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State | WI
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Zip | 53226-3548
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Country | US
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Telephone | 414-805-8576
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 WATERTOWN PLANK RD ATTN. CHAD LIPTOW, MS
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City | MILWAUKEE
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State | WI
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Zip | 53226
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Country | US
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Telephone | 414-805-8576
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | 53189
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License Number State | WI
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