MEDICARE: NATHAN T LEIGH M.D.

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	208200000X	Plastic Surgery Physician	31675	MN

General Provider Information

NPI Number	:	1184636144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN T LEIGH M.D.

Provider Business Mailing Address
First Line	:	6525 FRANCE AVE S STE 300
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-2177
Country	:	US
Telephone Number	:	952-925-1765
Fax Number	:

Provider Business Practice Location Address
First Line	:	6525 FRANCE AVE S STE 300
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-2177
Country	:	US
Telephone Number	:	952-925-1765
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	01/08/2014

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