Individual
HOLLY A. LEIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
(414) 247-4597
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
40183
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32626600
—
WI
01
—
P00679661
RR MEDICARE
WI
Enumeration date
06/26/2006
Last updated
10/02/2023
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