Individual
KEITH JAMES LEAVELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 6TH AVE N, CENTRACARE CLINIC, SAINT CLOUD, MN 56303-2735
(320) 252-5131
(320) 240-2118
Mailing address
1200 6TH AVE N, CENTRACARE CLINIC, SAINT CLOUD, MN 56303-2735
(320) 252-5131
(320) 240-2118
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
34628
MN
207RS0012X
Sleep Medicine (Internal Medicine) Physician
34628
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1011246
PREFERRED ONE
—
01
—
110122640
RR MEDICARE
—
01
—
112115
U CARE
—
01
—
2114069
FIRST HEALTH PLAN
—
01
—
27T22LE
BLUE CROSS BLUE SHIELD
—
01
—
4800134
MEDICA HEALTH PLANS
—
01
—
597042
ARAZ GROUP
—
01
—
928880500
MEDICAL ASSISTANCE MA
—
01
—
C11369
RR MEDICARE
—
01
—
COMP
MMSI
—
01
—
HP10860
HEALTH PARTNERS
—
Enumeration date
11/15/2005
Last updated
08/14/2013
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