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Organization

NEW LEAF MEDICAL, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SANDRA KAY WIITA MD (SOLE SHAREHOLDER)
(952) 777-2355
Entity
Organization

Contact information

Practice address
3622 COUNTY ROAD 101 S, WAYZATA, MN 55391-3424
(952) 777-2355
Mailing address
3622 COUNTY ROAD 101 S, WAYZATA, MN 55391-3424
(952) 777-2355

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
42376
MN

Other

Enumeration date
01/16/2014
Last updated
01/16/2014
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