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Individual

DR. DARIN TRACY LEETUN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3035 DEMERS AVE, GRAND FORKS, ND 58201-4040
(701) 746-7521
Mailing address
3035 DEMERS AVE, GRAND FORKS, ND 58201-4040
(701) 746-7521

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
8133
ND
207X00000X
Orthopaedic Surgery Physician
MI43084882
MI
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
NA
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0829560001
MEDICARE DME
MI
01
0C16002
MEDICARE GROUP
MI
05
104727842
MI
01
DL084882
BLUECROSS STATE ID
MI
Enumeration date
05/16/2006
Last updated
12/30/2020
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