Provider Demographics
NPI:1538174073
Name:LEPPIK, ILO ELMAR (MD)
Entity type:Individual
Prefix:
First Name:ILO
Middle Name:ELMAR
Last Name:LEPPIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 WAYZATA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1227
Mailing Address - Country:US
Mailing Address - Phone:952-525-4511
Mailing Address - Fax:952-525-1560
Practice Address - Street 1:5775 WAYZATA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-1227
Practice Address - Country:US
Practice Address - Phone:952-525-4511
Practice Address - Fax:952-525-1560
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN226172084N0400X
WI16819-0202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
41-1677590Other1ST CHOICE OF THE MIDWEST
71327LEOtherBLUE CROSS BLUE SHIELD
HP37157OtherHEALTHPARTNERS
01014966OtherPREFERRED ONE
41-1677590OtherWEA TRUST
MN167090500Medicaid
235558OtherAMERICA'S PPO
ND10088Medicaid
A006OtherTRIWEST
05-81577OtherMEDICA
130004895Medicare ID - Type UnspecifiedRAILROAD
130000345Medicare ID - Type Unspecified
01014966OtherPREFERRED ONE