Provider Demographics
NPI:1972126894
Name:LEBLANC, MARIE DANIELLE (MD, FRCSC)
Entity type:Individual
Prefix:DR
First Name:MARIE DANIELLE
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:MD, FRCSC
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FRCSC
Mailing Address - Street 1:600 E 5TH ST APT 1103
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-5415
Mailing Address - Country:US
Mailing Address - Phone:515-805-9992
Mailing Address - Fax:
Practice Address - Street 1:ANNA BLANK BUILDING, LEVEL 2, DEPT PEDIATRIC SURGERY
Practice Address - Street 2:1206 PLEASANT STREET
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309
Practice Address - Country:US
Practice Address - Phone:515-241-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-469422086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery