MEDICARE: DR. STACEY RAE LEJEUNE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	036178016	IL
2	2086S0129X	Vascular Surgery Physician	4301502411	MI
3	2086S0129X	Vascular Surgery Physician	61552	MN
4	2086S0129X	Vascular Surgery Physician	70750	WI

General Provider Information

NPI Number	:	1114261591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY RAE LEJEUNE M.D.

Provider Business Mailing Address
First Line	:	152108 TANAGER LN
Second Line	:
City	:	RIB MOUNTAIN
State	:	WI
Zip	:	54401-6737
Country	:	US
Telephone Number	:	715-213-8193
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 S PARK ST STE A
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53715-1830
Country	:	US
Telephone Number	:	608-260-2900
Fax Number	:	608-260-2976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2012
Last Update Date	:	04/08/2026

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