Individual
LEELA C THACHENKARY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7107-49TH AVE, KENOSHA, WI 53142
(262) 694-1292
Mailing address
7107-49TH AVE, KENOSHA, WI 53142
(262) 694-1292
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
24425-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24425-020
STATEOFWISCONSIN
WI
Enumeration date
07/01/2008
Last updated
07/01/2008
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