=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770104408
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOGAN KAHLEB LEON PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2020
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17406 ROYALTON RD STE B
-----------------------------------------------------
City | STRONGSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44136-5144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-472-0900
-----------------------------------------------------
Fax | 440-472-0902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1225 TOWNSHIP ROAD 1453
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44805-9359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-908-8012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 50009402RX
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------