MEDICARE: DR. HARRY LAYTON LESMANA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207SG0201X	Clinical Genetics (M.D.) Physician	35.138105	OH
2	2080P0207X	Pediatric Hematology & Oncology Physician	35.138105	OH
3	208000000X	Pediatrics Physician	35.138105	OH

General Provider Information

NPI Number	:	1053675587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRY LAYTON LESMANA M.D.

Provider Business Mailing Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 5012
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3026
Country	:	US
Telephone Number	:	513-636-4315
Fax Number	:	513-636-7905

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-3026
Country	:	US
Telephone Number	:	513-636-4315
Fax Number	:	513-636-7905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	11/15/2023

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