Organization
NORTHEAST PEDIATRIC CLINIC P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY ANN LEUKUMA M.D. (CEO)
(651) 426-1141
Entity
Organization
Contact information
Practice address
4520 CENTERVILLE RD, VADNAIS HEIGHTS, MN 55127-3602
(651) 426-1141
(651) 426-1705
Mailing address
4520 CENTERVILLE RD, VADNAIS HEIGHTS, MN 55127-3602
(651) 426-1141
(651) 426-1705
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
11/29/2005
Last updated
08/22/2020
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