Provider Demographics
NPI:1184652414
Name:SLECKMAN, JOSEPH B (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:SLECKMAN
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4923207RR0500X
MN29183207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3200072OtherMEDICA #
ND14356Medicaid
MN54828SLOtherMNBS #
NDND200061OtherLHS #
ND3200086OtherMEDICA #
MN48617SLOtherMNBS #
ND911594OtherAMERICA'S PPO/ARAZ #
MN6430OtherNDBS #
NDDA9011015589OtherPREFERRED ONE #
ND06335SLOtherMNBS #
ND91643SLOtherMNBS #
MN10016OtherNDBS #
ND1285OtherNDBS #
ND2284OtherNDBS #
ND79889SLOtherMNBS #
ND1285OtherNDBS #
ND2284OtherNDBS #
ND3200072OtherMEDICA #
MN48617SLOtherMNBS #
ND110072880Medicare UPIN