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NPI Code Detail

MEDICARE: LESLIE G LOFGREN MD

MEDICARE: LESLIE G LOFGREN MD
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
1207Q00000XFamily Medicine Physician27162MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720049752
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE G LOFGREN MD
Provider Business Mailing Address
First Line : 2251 CONNECTICUT AVE S
Second Line :
City : SARTELL
State : MN
Zip : 56377-2486
Country : US
Telephone Number : 320-253-5220
Fax Number : 320-203-2113
Provider Business Practice Location Address
First Line : 2251 CONNECTICUT AVE S
Second Line :
City : SARTELL
State : MN
Zip : 56377-2486
Country : US
Telephone Number : 320-253-5220
Fax Number : 320-203-2113
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 12/02/2015

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Directions to “ LESLIE G LOFGREN MD” Practice Location

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