Provider Demographics
NPI:1134195027
Name:SWARTZ-WILLIAMS, LESLIE (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SWARTZ-WILLIAMS
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 1:1601 SAINT FRANCIS AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3383
Mailing Address - Country:US
Mailing Address - Phone:952-428-3535
Mailing Address - Fax:
Practice Address - Street 1:1601 SAINT FRANCIS AVE
Practice Address - Street 2:STE 100
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3383
Practice Address - Country:US
Practice Address - Phone:952-428-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN108138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400215052Medicare PIN
IN200375620Medicaid
IN260690FMedicare PIN
INH12436Medicare UPIN
IN000000221112OtherANTHEM
OH2317586Medicaid
110237979OtherRAILROAD