Provider Demographics
NPI:1891904165
Name:LEINBACH, ROXANA FLORINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:FLORINA
Last Name:LEINBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1421
Mailing Address - Country:US
Mailing Address - Phone:651-292-2013
Mailing Address - Fax:
Practice Address - Street 1:166 4TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1421
Practice Address - Country:US
Practice Address - Phone:651-292-2000
Practice Address - Fax:651-292-2013
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA380472085R0202X
WI536842085R0202X
IAR-72962085R0202X
MN526842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1891904165Medicaid
IA421417307V0OtherUHC/RIVER VALLEY/JD
IA1891904165Medicaid