MEDICARE: LEANN TULISIAK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	34.017879	OH

General Provider Information

NPI Number	:	1669113601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANN TULISIAK DO

Provider Business Mailing Address
First Line	:	18101 LORAIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5612
Country	:	US
Telephone Number	:	216-476-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 W 25TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3108
Country	:	US
Telephone Number	:	216-696-4300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	10/07/2025

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