Healthcare Provider Details

I. General information

NPI: 1285749135
Provider Name (Legal Business Name): LEROY J DIERKER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR MHMC-OB/GYN
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

2500 METROHEALTH DR MHMC-OB/GYN
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-7857
  • Fax:
Mailing address:
  • Phone: 216-778-7857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35039642
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: