MEDICARE: LEAH N EDERER MD

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	207Q00000X	Family Medicine Physician	48304	WI

General Provider Information

NPI Number	:	1689643975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH N EDERER MD

Provider Business Mailing Address
First Line	:	112 HELEN ST
Second Line	:
City	:	SAUK CITY
State	:	WI
Zip	:	53583-1168
Country	:	US
Telephone Number	:	608-643-3351
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 HELEN ST
Second Line	:
City	:	SAUK CITY
State	:	WI
Zip	:	53583-1168
Country	:	US
Telephone Number	:	608-643-3351
Fax Number	:

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	08/19/2020

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Directions to “ LEAH N EDERER MD” Practice Location

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