Healthcare Provider Details

I. General information

NPI: 1083664130
Provider Name (Legal Business Name): LEONARD READ SULIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

12915 63RD AVE N
MAPLE GROVE MN
55369-6001
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-2715
  • Fax:
Mailing address:
  • Phone: 763-383-5800
  • Fax: 763-559-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number42089
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberCDR.0006750
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number42089
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: