MEDICARE: LEONARDO DE CASTRO DURAES MD, PHD

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	208C00000X	Colon & Rectal Surgery Physician	D86049	MD
2	208C00000X	Colon & Rectal Surgery Physician	35.140717	OH

General Provider Information

NPI Number	:	1720515968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARDO DE CASTRO DURAES MD, PHD

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE # A3
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:	216-744-6009
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE # A3
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0005
Country	:	US
Telephone Number	:	216-744-6009
Fax Number	:	216-445-8627

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

Provider Enumeration Date	:	05/18/2017
Last Update Date	:	09/10/2021

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