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NPI Code Detail

MEDICARE: LEONARDO T QUE M.D.

MEDICARE: LEONARDO T QUE 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
1207RC0000XCardiovascular Disease Physician35-05-0504OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356346258
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONARDO T QUE M.D.
Provider Business Mailing Address
First Line : 611 FULTON ST
Second Line : SUITE E
City : PORT CLINTON
State : OH
Zip : 43452
Country : US
Telephone Number : 419-734-4539
Fax Number : 419-734-6365
Provider Business Practice Location Address
First Line : 611 FULTON ST
Second Line : SUITE E
City : PORT CLINTON
State : OH
Zip : 43452-2008
Country : US
Telephone Number : 419-734-4539
Fax Number : 419-734-6365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 10/06/2020

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Directions to “ LEONARDO T QUE M.D.” Practice Location

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