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General NPI Number Information
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NPI Number | 1447249677
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Entity Type | Individual
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Provider Name | JONATHAN B LEIZMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 17747 CHILLICOTHE RD SUITE 100
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City | CHAGRIN FALLS
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State | OH
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Zip | 44023-4739
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Country | US
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Telephone | 440-543-8855
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Fax | 440-543-2470
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Provider Business Mailing Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-444-2200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35075091L
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 35075091
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License Number State | OH
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