Individual
DR. LEIGHTON MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9200 W WISCONSIN AVE, DEPARTMENT OF RADIOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-3700
(414) 805-3777
Mailing address
9200 W WISCONSIN AVE, DEPARTMENT OF RADIOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-3700
(414) 805-3777
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
25648
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002000124I
HUMANA
—
05
—
1114970852
—
WI
01
—
300041524
RAILROAD MEDICARE
—
Enumeration date
05/17/2006
Last updated
05/13/2014
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