Basic Information
| Provider Information | |||||||||
| NPI: | 1326279118 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEDER | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | AUSTIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 1ST ST SW | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087850940 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 WEST AVE S | ||||||||
| Address2: | |||||||||
| City: | LA CROSSE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083927000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2009 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 65717 | WI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 4301095141 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.