Individual provider Active NPI

Leo Booker Laub, M.D.

  • Internal Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1396199741
Registry record updated Sep 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
64874 Issued in MN
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 672-6000
Fax
(612) 273-4098
NPI assigned
Apr 21, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 64874 MN Primary

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

420 Delaware St SE
MMC 284
Minneapolis, MN 55455-0341
Phone (612) 626-5031

Other practice location 1

420 Delaware St SE
MMC 284
Minneapolis, MN 55455-0341
Phone (612) 626-5031

Other practice location 2

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 626-3343

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190709002364 MN Practitioner - Internal Medicine 6709121916 Reassigns benefits to 6 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
64874MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Healtheast Woodwinds Hospital CurrentSince Apr 4, 2020 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Apr 4, 2020 Accepting new patients
Fairview Bethesda Hospital CurrentSince Apr 4, 2020 Accepting new patients
Healtheast Medical Research Institute CurrentSince Mar 1, 2020 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast St. John'S Hospital CurrentSince Apr 4, 2020 Accepting new patients
Fairview Health Services CurrentSince Jun 15, 2019 Accepting new patients
Healtheast Medical Research Institute Internal Medicine CurrentSince Mar 1, 2020 Accepting new patients
Healtheast Care System CurrentSince Apr 4, 2020 Accepting new patients
Fairview Clinics CurrentSince Apr 4, 2020 Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

420 Delaware St SE
Ste MMC284
Minneapolis, MN 55455
Phone (612) 625-5454

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

559 Capitol Blvd
Saint Paul, MN 55103
Phone (651) 232-2000

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

1700 University Ave W
Fl 1
Saint Paul, MN 55104
Phone (651) 232-2002

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1396199741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "MMC 284",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-626-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-672-6000",
            "fax_number": "612-273-4098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 Delaware St SE",
            "address_2": "MMC 284",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554550341",
            "country_code": "US",
            "telephone_number": "612-626-5031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 Harvard St SE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554550363",
            "country_code": "US",
            "telephone_number": "612-626-3343",
            "fax_number": "612-626-3366",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAUB",
        "first_name": "LEO",
        "middle_name": "BOOKER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-21",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "64874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.