Healthcare Provider Details

I. General information

NPI: 1700981479
Provider Name (Legal Business Name): DOMINIC S. LEFOER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9318 STATE ROUTE 14
STREETSBORO OH
44241-5224
US

IV. Provider business mailing address

8018 MEADOWBROOKE TRL
POLAND OH
44514-5326
US

V. Phone/Fax

Practice location:
  • Phone: 330-626-3111
  • Fax: 330-626-5978
Mailing address:
  • Phone: 330-707-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-067754
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: