Healthcare Provider Details

I. General information

NPI: 1548203623
Provider Name (Legal Business Name): MICHAEL GREGORY LEADBETTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 RED BANK RD 1 PLASTIC SURGERY PLAZA
CINCINNATI OH
45227-1545
US

IV. Provider business mailing address

4850 RED BANK RD 1 PLASTIC SURGERY PLAZA
CINCINNATI OH
45227-1545
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-4440
  • Fax: 513-985-6615
Mailing address:
  • Phone: 513-791-4440
  • Fax: 513-985-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35040615
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number30840
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: