Individual
DR. CHARLES R LEADHOLM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
252 MCHENRY ST, BURLINGTON, WI 53105-1828
(262) 767-6100
(262) 767-6098
Mailing address
7071 S 13TH ST, STE 104, OAK CREEK, WI 53154-1466
(414) 570-7106
(414) 570-7136
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
20148
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30775700
—
WI
Enumeration date
04/06/2006
Last updated
07/08/2007
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