MEDICARE: DR. LESLIE P NIEHAUS DPM

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	213E00000X	Podiatrist	36001977	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1407802739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE P NIEHAUS DPM

Provider Business Mailing Address
First Line	:	440 E STATE ST
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-4910
Country	:	US
Telephone Number	:	330-821-6438
Fax Number	:	330-821-8433

Provider Business Practice Location Address
First Line	:	440 E STATE ST
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-4910
Country	:	US
Telephone Number	:	330-821-6438
Fax Number	:	330-821-8433

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	01/18/2022

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Directions to “ DR. LESLIE P NIEHAUS DPM” Practice Location

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