Provider Demographics
NPI:1831180736
Name:LEONARD, SUSAN A (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7600 FRANCE AVE S STE 5100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5924
Mailing Address - Country:US
Mailing Address - Phone:952-832-0246
Mailing Address - Fax:952-832-0249
Practice Address - Street 1:7600 FRANCE AVE S STE 5100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-832-0246
Practice Address - Fax:952-832-0249
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42684207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
847950000OtherMEDICAL ASSISTANCE MA
H68421Medicare UPIN
1607102OtherARAZ GROUP AMERICAS PPO
6D053CEOtherBLUE CROSS BLUE SHIELD
HP35643OtherHEALTH PARTNERS
1030711OtherPREFERRED ONE
142149OtherUCARE
290G4LEOtherBLUE CROSS BLUE SHIELD
H68421Medicare UPIN
3200166OtherMEDICA HEALTH PLANS