Healthcare Provider Details

I. General information

NPI: 1629009444
Provider Name (Legal Business Name): LEO THEODORE FURCHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE UNIVERSITY OF MINNESOTA PHYSICIANS420
MINNEAPOLIS MN
55455-0341
US

IV. Provider business mailing address

420 DELAWARE ST SE UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-0622
  • Fax: 612-626-2696
Mailing address:
  • Phone: 612-626-0622
  • Fax: 612-626-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number23527
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: