MEDICARE: LEONARD READ SULIK MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	42089	MN
2	2084P0804X	Child & Adolescent Psychiatry Physician	42089	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083664130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD READ SULIK MD

Provider Business Mailing Address
First Line	:	12915 63RD AVE N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-6001
Country	:	US
Telephone Number	:	763-383-5800
Fax Number	:	763-559-6450

Provider Business Practice Location Address
First Line	:	3415 SAINT PAUL AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4342
Country	:	US
Telephone Number	:	612-284-3220
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	05/14/2021

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