Provider Demographics
NPI:1760454524
Name:VAN PASSEL, LEONIE M (MD)
Entity Type:Individual
Prefix:
First Name:LEONIE
Middle Name:M
Last Name:VAN PASSEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2881 HYDE PARK ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3228
Mailing Address - Country:US
Mailing Address - Phone:941-906-7155
Mailing Address - Fax:941-330-2905
Practice Address - Street 1:2881 HYDE PARK ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3228
Practice Address - Country:US
Practice Address - Phone:941-906-7155
Practice Address - Fax:941-330-2905
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME944132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I47103Medicare UPIN
FL30991ZMedicare PIN