Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 37803 | MN |
N | 207X00000X | Orthopaedic Surgeon | A-1685-12 | NM |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 37803 | MN |
N | 207XS0106X | Orthopaedic Hand Surgeon | 37803 | MN |
N | 207XS0106X | Orthopaedic Hand Surgeon | A-1685-12 | NM |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 37803 | MN |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A-1685-12 | NM |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 37803 | MN |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A-1685-12 | NM |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 37803 | MN |
N | 207XX0801X | Orthopaedic Trauma Surgeon | A-1685-12 | NM |
NPI | 1225018302 |
---|---|
Provider Name | Dr. Leo L Hise II |
First Address | Hibbing, MN 55746-2935 |
Second Address | Hibbing, MN 55746-2935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 03/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
257865YKR1 | (02) | NM |
71551336 | (05) | NM |
C78396 | (02) | MN |