Healthcare Provider Details

I. General information

NPI: 1750325718
Provider Name (Legal Business Name): JEFFREY ROGERS LEIPZIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7927 JESSIES WAY
HAMILTON OH
45011-8077
US

IV. Provider business mailing address

9800 SHELBYVILLE RD STE 220
LOUISVILLE KY
40223-2992
US

V. Phone/Fax

Practice location:
  • Phone: 513-894-0500
  • Fax: 513-894-0600
Mailing address:
  • Phone: 502-429-8585
  • Fax: 502-429-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35.074376
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number35074376L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: