Provider Demographics
NPI:1790987709
Name:ROWAN-KELLY, LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:
Last Name:ROWAN-KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:CHARLES LEIGH
Other - Last Name:ROWAN-KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD FASAM
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 SWANTOWN HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06359-1022
Practice Address - Country:US
Practice Address - Phone:860-445-3662
Practice Address - Fax:860-709-9365
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58842207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR390200000XOtherTAXONOMY