MEDICARE: DR. LELAND KARL MARTIN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	LP3095	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	HP27418	OTHER	MN	HEALTH PARTNERS
3	6129689	OTHER	MN	UNITED BEHAVIORAL HEALTH
4	169220	OTHER	MN	COMPSYCH
5	5H813MA	OTHER	MN	BLUE CROSS BLUE SHIELD
6	109951	OTHER	MN	BEHAVIORAL HEALTH CARE PR

General Provider Information

NPI Number	:	1003855743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LELAND KARL MARTIN PHD

Provider Business Mailing Address
First Line	:	2434 COMMERCE BLVD STE A
Second Line	:
City	:	MOUND
State	:	MN
Zip	:	55364-1480
Country	:	US
Telephone Number	:	952-595-0562
Fax Number	:	952-595-0564

Provider Business Practice Location Address
First Line	:	2434 COMMERCE BLVD STE A
Second Line	:
City	:	MOUND
State	:	MN
Zip	:	55364-1480
Country	:	US
Telephone Number	:	952-595-0562
Fax Number	:	952-595-0564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/07/2022

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