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General NPI Number Information
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NPI Number | 1740214014
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Entity Type | Individual
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Provider Name | MARIE CHRISTINE LEISZ DO
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 280 NORTH SMITH AVENUE DOCTORS PROFESSIONAL BUILDING
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City | ST. PAUL
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State | MN
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Zip | 55102-2459
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Country | US
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Telephone | 651-241-8295
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 CHICAGO AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1321
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Country | US
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Telephone | 651-241-8295
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 40993
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License Number State | MN
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