Healthcare Provider Details

I. General information

NPI: 1851706782
Provider Name (Legal Business Name): LEENAH ABUGISISA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 10/11/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2568
  • Fax: 216-444-7625
Mailing address:
  • Phone: 216-444-2568
  • Fax: 216-444-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35152053
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: