MEDICARE: DR. WILLIAM JOHN LEAHY MD

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	207Q00000X	Family Medicine Physician	35075211	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	:	1447245774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM JOHN LEAHY MD

Provider Business Mailing Address
First Line	:	825 S CABLE RD
Second Line	:	SUITE A
City	:	LIMA
State	:	OH
Zip	:	45805-3467
Country	:	US
Telephone Number	:	419-224-1234
Fax Number	:	419-224-6800

Provider Business Practice Location Address
First Line	:	825 S CABLE RD
Second Line	:	SUITE A
City	:	LIMA
State	:	OH
Zip	:	45805-3467
Country	:	US
Telephone Number	:	419-224-1234
Fax Number	:	419-224-6800

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	03/25/2008

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