Provider Demographics
NPI:1831158914
Name:LEUCK, KATHERINE ANNE (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:LEUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5435 FELTL RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7983
Mailing Address - Country:US
Mailing Address - Phone:952-835-9880
Mailing Address - Fax:952-857-1554
Practice Address - Street 1:6500 EXCELSIOR BLVD
Practice Address - Street 2:METHODIST HOSPITAL
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426
Practice Address - Country:US
Practice Address - Phone:952-993-6080
Practice Address - Fax:952-993-6047
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46033207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN397195300Medicaid
MN46033OtherMN MEDICAL LICENSE
H99050Medicare UPIN
930002079Medicare ID - Type Unspecified