Healthcare Provider Details

I. General information

NPI: 1902236896
Provider Name (Legal Business Name): PREMISE HEALTH OF OHIO MEDICAL, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 CARDINAL PL
DUBLIN OH
43017-1091
US

IV. Provider business mailing address

5500 MARYLAND WAY SUITE 120
BRENTWOOD TN
37027-4993
US

V. Phone/Fax

Practice location:
  • Phone: 614-553-3830
  • Fax: 614-553-3831
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN B LEIZMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 844-407-7557