Provider Demographics
NPI:1144457466
Name:DVORAK, LEAH ANN (DO)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:ANN
Last Name:DVORAK
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:301 BECKER AVENUE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3302
Practice Address - Country:US
Practice Address - Phone:320-235-4574
Practice Address - Fax:320-231-4503
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2015-05-28
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Provider Licenses
StateLicense IDTaxonomies
MN55888207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN220001691Medicare PIN