Healthcare Provider Details

I. General information

NPI: 1487452454
Provider Name (Legal Business Name): GREGORY LEIMKUEHLER CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 DETROIT AVE
CLEVELAND OH
44102-2295
US

IV. Provider business mailing address

4625 DETROIT AVE
CLEVELAND OH
44102-2295
US

V. Phone/Fax

Practice location:
  • Phone: 216-651-7788
  • Fax: 216-651-4057
Mailing address:
  • Phone: 216-651-7788
  • Fax: 216-651-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number00287
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number00287
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: