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General NPI Number Information
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NPI Number | 1023279197
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Entity Type | Individual
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Provider Name | MARK LEENAY M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2008
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Last Update Date | 06/22/2008
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Provider Practice Location Address
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Address Line | 6940 338TH LN NW
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City | PRINCETON
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State | MN
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Zip | 55371-5007
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Country | US
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Telephone | 763-389-9417
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Fax |
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Provider Business Mailing Address
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Address Line | 6940 338TH LN NW
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City | PRINCETON
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State | MN
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Zip | 55371-5007
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Country | US
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Telephone | 763-389-9417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 33571
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 33571
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 33571
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License Number State | MN
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