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Individual

MARK LINUS LEITSCHUH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
13133 N PORT WASHINGTON RD, SUITE 122, MEQUON, WI 53097-2419
(262) 243-3700
(262) 243-3701
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(262) 243-3700
(262) 243-3701

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
31195
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
31602900
WI
Enumeration date
12/01/2006
Last updated
06/12/2012
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