Leadholm, Charles R

Leadholm, Charles R is an individual health care provider with primary practice located at 252 Mchenry St , Burlington WI 53105-1828. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medical Services, which is considered as his primary health care specialty. Leadholm, Charles R can be contacted via phone (262) 767-6100.

Contact Information

Primary practice address
252 Mchenry St Burlington WI 53105-1828
Phone: (262) 767-6100
Fax: (262) 767-6098
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X 20148 Wisconsin

Profile Details

NPI number 1194787846
LBN Legal business name Leadholm, Charles R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 6th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194787846 NPPES
Wisconsin MEDICAID 30775700

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