Provider Demographics
NPI:1649232224
Name:AVENIDO, LEO FRANCIS P (MD)
Entity Type:Individual
Prefix:
First Name:LEO FRANCIS
Middle Name:P
Last Name:AVENIDO
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 43
Mailing Address - Street 2:MR 10809
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:21260 CHIPPENDALE AVE W
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-1427
Practice Address - Country:US
Practice Address - Phone:651-463-7181
Practice Address - Fax:651-460-7184
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN824223200Medicaid
080012661Medicare ID - Type Unspecified
H04094Medicare UPIN