MEDICARE: DR. MARYLEE S. LEGRIED 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	207Q00000X	Family Medicine Physician	39373	MN

General Provider Information

NPI Number	:	1649232273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYLEE S. LEGRIED M.D.

Provider Business Mailing Address
First Line	:	53208 395TH ST
Second Line	:
City	:	NEW YORK MILLS
State	:	MN
Zip	:	56567-9031
Country	:	US
Telephone Number	:	218-640-3875
Fax Number	:	218-385-3306

Provider Business Practice Location Address
First Line	:	53208 395TH ST
Second Line	:
City	:	NEW YORK MILLS
State	:	MN
Zip	:	56567-9031
Country	:	US
Telephone Number	:	218-640-3875
Fax Number	:	218-385-3306

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	10/06/2016

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