Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 24365 | MN |
NPI | 1003891565 |
---|---|
Provider Name | Leslie Pratt |
First Address | St Louis Park, MN 55416-2527 |
Second Address | St Louis Park, MN 55426-4375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 06/03/2012 |