Provider Demographics
NPI:1649232273
Name:LEGRIED, MARYLEE S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYLEE
Middle Name:S
Last Name:LEGRIED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:53208 395TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56567-9031
Mailing Address - Country:US
Mailing Address - Phone:218-640-3875
Mailing Address - Fax:218-385-3306
Practice Address - Street 1:53208 395TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK MILLS
Practice Address - State:MN
Practice Address - Zip Code:56567-9031
Practice Address - Country:US
Practice Address - Phone:218-640-3875
Practice Address - Fax:218-385-3306
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN39373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG04965Medicare UPIN
MN818524700Medicaid