Healthcare Provider Details

I. General information

NPI: 1407802754
Provider Name (Legal Business Name): JOHN J. LEISGANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 MARIE AVE
CINCINNATI OH
45248
US

IV. Provider business mailing address

5525 MARIE AVE
CINCINNATI OH
45248-3230
US

V. Phone/Fax

Practice location:
  • Phone: 513-981-5463
  • Fax: 513-598-2242
Mailing address:
  • Phone: 513-981-5463
  • Fax: 513-598-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35045220
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: