Facts
- Status
- A
- Credential
- M.D.
- Type
- Individual
- Enumeration date
- 2006-01-04
- Last updated
- 2026-07-13
Specialties
Licenses
- License MN
- 27733
Location
- Practice location
- 1550 HWY 71 NE, WILLMAR REGIONAL TREATMENT CENTER
- City
- WILLMAR MN
- Postal code
- 562019599
- Phone
- 320-231-5100
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.