Provider Demographics
NPI:1629009444
Name:FURCHT, LEO THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:THEODORE
Last Name:FURCHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-626-0622
Mailing Address - Fax:612-626-2696
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS420
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-626-0622
Practice Address - Fax:612-626-2696
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN23527207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP22288OtherHEALTHPARTNERS
WI31623700Medicaid
MN1009107OtherPREFERRED ONE
IA0512624Medicaid
MN9G687FROtherBCBS
SD7777470Medicaid
MN101357OtherUCARE
ND10387Medicaid
MN11-22568OtherMEDICA CHOICE
MN11-74549OtherMEDICA PRIMARY
MT0051799Medicaid
MN768120OtherARAZ
IA0512624Medicaid