Provider Demographics
NPI:1184636144
Name:LEIGH, NATHAN T (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:T
Last Name:LEIGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 FRANCE AVE S STE 300
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2177
Mailing Address - Country:US
Mailing Address - Phone:952-925-1765
Mailing Address - Fax:
Practice Address - Street 1:6525 FRANCE AVE S STE 300
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2177
Practice Address - Country:US
Practice Address - Phone:952-925-1765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31675208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA93968Medicare UPIN
MN240000070Medicare ID - Type Unspecified