Provider Demographics
NPI:1275728677
Name:LEUCK, ANNE-MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANNE-MARIE
Middle Name:
Last Name:LEUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MAYO BUILDING MMC 250
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-625-4680
Mailing Address - Fax:612-625-4410
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MAYO BUILDING MMC 250
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-625-4680
Practice Address - Fax:612-625-4410
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-09
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN261QM1300X207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN54714OtherMINNESOTA MEDICAL LICENSE