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Individual

DAVID LEROY CAMENGA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
420 E STARK RD, MILTON, WI 53563-8300
(320) 630-3203
Mailing address
420 E STARK RD, MILTON, WI 53563-8300
(320) 630-3203

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
31440
MN
2084N0400X
Neurology Physician
31720-020
WI
2084N0400X
Neurology Physician
ME 93547
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
287508000
MN
05
32753000
WI
05
38724800
WI
Enumeration date
09/27/2007
Last updated
09/27/2007
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