MEDICARE: WAYNE FREDERICK LEEBAW MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	23267	MN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120263C626	OTHER	MN	UCARE
2	21002	OTHER	MN	AMERICA'S PPO
3	3317283	OTHER	MN	MEDICA CHOICE
4	410999025	OTHER	MN	TRICARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0256006	OTHER	MN	SELECT CARE
7	3300003	OTHER	MN	MEDICA PRIMARY
8	HP13803	OTHER	MN	HEALTH PARTNERS
9	53967LE	OTHER	MN	BLUE CROSS BLUE SHIELD
10	960540799004	OTHER	MN	PREFERRED ONE
11	104082	OTHER	MN	PATIENT CHOICE

NPI Number	:	1033178405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE FREDERICK LEEBAW MD

Provider Business Mailing Address
First Line	:	7701 YORK AVE S
Second Line	:	SUITE 180
City	:	EDINA
State	:	MN
Zip	:	55435-5845
Country	:	US
Telephone Number	:	952-927-7810
Fax Number	:	952-927-6309

Provider Business Practice Location Address
First Line	:	7701 YORK AVE S
Second Line	:	SUITE 180
City	:	EDINA
State	:	MN
Zip	:	55435-5845
Country	:	US
Telephone Number	:	952-927-7810
Fax Number	:	952-927-6309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	05/06/2008

7701 YORK AVE S STE 140
EDINA, MN
55435-5845

Practice Phone: 952-956-6700
Practice Fax:

7701 YORK AVE S STE 180
EDINA, MN
55435-5845