Healthcare Provider Details

I. General information

NPI: 1881629616
Provider Name (Legal Business Name): LEON S MENSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PL
SOLDOTNA AK
99669-6999
US

IV. Provider business mailing address

PO BOX 1228
KASILOF AK
99610
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4502
  • Fax:
Mailing address:
  • Phone: 907-345-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number6964
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: