MEDICARE: LESLEE J JAEGER M.D.

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	207V00000X	Obstetrics & Gynecology Physician	34320	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	:	1346286838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEE J JAEGER M.D.

Provider Business Mailing Address
First Line	:	9875 HOSPITAL DRIVE
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369
Country	:	US
Telephone Number	:	763-581-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	9875 HOSPITAL DR
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-4648
Country	:	US
Telephone Number	:	763-581-1100
Fax Number	:

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	02/21/2024

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