Basic Information
| Provider Information | |||||||||
| NPI: | 1669499299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RITZ | ||||||||
| FirstName: | LEONE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | JOHNSON | ||||||||
| OtherFirstName: | LEONE | ||||||||
| OtherMiddleName: | D | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6025 LAKE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551251712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519996800 | ||||||||
| FaxNumber: | 6519996830 | ||||||||
| Practice Location | |||||||||
| Address1: | 6025 LAKE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551251712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519996800 | ||||||||
| FaxNumber: | 6519996830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 03/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 37883 | MN | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.