Individual
LEO PASSOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-2218
(612) 873-1614
Mailing address
7259 S BINGHAM JUNCTION BLVD, MIDVALE, UT 84047-4860
(801) 930-3110
(800) 437-5541
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
50942
MN
2084P0800X
Psychiatry Physician
57535-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35353800
—
WI
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
Enumeration date
07/24/2007
Last updated
08/24/2022
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