Healthcare Provider Details

I. General information

NPI: 1891891958
Provider Name (Legal Business Name): JAMES BRUCE LEVERENZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # U10
CLEVELAND OH
44195-1532
US

IV. Provider business mailing address

PO BOX 245
GATES MILLS OH
44040-0245
US

V. Phone/Fax

Practice location:
  • Phone: 216-636-9467
  • Fax: 166-362-6452
Mailing address:
  • Phone: 440-804-4452
  • Fax: 216-445-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number35.122698
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: