Healthcare Provider Details

I. General information

NPI: 1447249677
Provider Name (Legal Business Name): JONATHAN B LEIZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30799 PINETREE RD # 145
PEPPER PIKE OH
44124-5903
US

IV. Provider business mailing address

30799 PINETREE RD # 145
PEPPER PIKE OH
44124-5903
US

V. Phone/Fax

Practice location:
  • Phone: 216-479-9063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35075091
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35075091L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: