Provider Demographics
NPI:1538169933
Name:LEIGHTON, DANIELLE B (MD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:B
Last Name:LEIGHTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:B
Other - Last Name:VIETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7366
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-7366
Mailing Address - Country:US
Mailing Address - Phone:320-257-5595
Mailing Address - Fax:320-257-5596
Practice Address - Street 1:1990 CONNECTICUT AVE S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2554
Practice Address - Country:US
Practice Address - Phone:320-257-5595
Practice Address - Fax:320-257-5596
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN455712085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1841019OtherARAZ/ AMERICA'S PPO
MN411772562OtherTRICARE
MN227M1LEOtherBLUE CROSS BLUE SHIELD
MNHP38570OtherHEALTH PARTNERS
MN16-02512OtherMEDICA
MN689438100Medicaid
MN965251034498OtherPREFERRED ONE
MNP00025240OtherRAILROAD MEDICARE
MN171485C561OtherUCARE OF MINNESOTA
MN411772562OtherGREATWEST HEALTHCARE
MN1841019OtherARAZ/ AMERICA'S PPO
MN411772562OtherTRICARE