Individual
LESLIE L GOODAVISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MMS PAC
Contact information
Practice address
4602 EASTPARK BLVD, MADISON, WI 53718-2002
(608) 263-8820
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
(608) 829-5485
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1933-23
WI
363A00000X
Physician Assistant
MED-PAC-LIC-79429
MT
Other
Enumeration date
04/04/2006
Last updated
02/15/2021
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