MEDICARE: SAMANTHA MARIE LEASE DO

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	207P00000X	Emergency Medicine Physician	81708	WI
2	207Q00000X	Family Medicine Physician	81708-21	WI
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1336834662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MARIE LEASE DO

Provider Business Mailing Address
First Line	:	2009 5TH ST
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-1546
Country	:	US
Telephone Number	:	608-324-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W 8TH ST
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-1021
Country	:	US
Telephone Number	:	608-324-2000
Fax Number	:

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

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	07/16/2025

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Directions to “ SAMANTHA MARIE LEASE DO” Practice Location

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