Healthcare Provider Details

I. General information

NPI: 1609220177
Provider Name (Legal Business Name): JOSE OYAMA MOURA LEITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE
CINCINNATI OH
45219-4231
US

IV. Provider business mailing address

231 ALBERT SABIN WAY ML 0558
CINCINNATI OH
45267-0558
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-3700
  • Fax: 513-558-5036
Mailing address:
  • Phone: 513-558-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.136546
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: