Provider Demographics
NPI:1881629616
Name:MENSCH, LEON S (MD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:S
Last Name:MENSCH
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 1228
Mailing Address - Street 2:
Mailing Address - City:KASILOF
Mailing Address - State:AK
Mailing Address - Zip Code:99610
Mailing Address - Country:US
Mailing Address - Phone:907-345-0004
Mailing Address - Fax:
Practice Address - Street 1:250 HOSPITAL PL
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-6999
Practice Address - Country:US
Practice Address - Phone:907-714-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6964207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1881629616OtherNPI
VTOVN2759Medicaid
AK1575802Medicaid
VTH51015Medicare UPIN