MEDICARE: LEAH FECIK

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	363A00000X	Physician Assistant	MA067290	PA

General Provider Information

NPI Number	:	1780554907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH FECIK

Provider Business Mailing Address
First Line	:	3674 S WASHINGTON ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-5766
Country	:	US
Telephone Number	:	701-205-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3674 S WASHINGTON ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-5766
Country	:	US
Telephone Number	:	701-205-3000
Fax Number	:

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

Provider Enumeration Date	:	11/11/2025
Last Update Date	:	11/11/2025

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Directions to “ LEAH FECIK ” Practice Location

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