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General NPI Number Information
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NPI Number | 1588194021
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Entity Type | Individual
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Provider Name | MITCHEL LEERS PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 6936 PINE ARBOR DR S STE 100
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4661
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Country | US
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Telephone | 651-326-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 UNIVERSITY AVE W FL 6
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City | SAINT PAUL
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State | MN
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Zip | 55104-3727
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5420
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 13346
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License Number State | MN
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