Provider Demographics
NPI:1265753727
Name:KING-SCHULTZ, LESLIE W (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:W
Last Name:KING-SCHULTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:W
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS G7.373
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-2064
Mailing Address - Fax:612-904-4284
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS G7.373
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2064
Practice Address - Fax:612-904-4284
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54157208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN370004472Medicare PIN