Provider Demographics
NPI:1740214014
Name:LEISZ, MARIE CHRISTINE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:CHRISTINE
Last Name:LEISZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:651-241-8295
Mailing Address - Fax:
Practice Address - Street 1:280 NORTH SMITH AVENUE
Practice Address - Street 2:DOCTORS PROFESSIONAL BUILDING
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2459
Practice Address - Country:US
Practice Address - Phone:651-241-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40993208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNBLUECROSS BLUESHIELDOtherBLUECROSS BLUE SHIELD
2311446OtherMEDICA - CHOICE
HP28829OtherHEALTHPARTNERS
IA0511188Medicaid
1017577OtherPREFERREDONE
122837OtherUCARE
23-00008OtherMEDICA - PRIMARY
WI32446800Medicaid
MN071729100Medicaid
ARAZOther835296
23-00008OtherMEDICA - PRIMARY
122837OtherUCARE
G84445Medicare UPIN