MEDICARE: LEONARD KING

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	376K00000X	Nurse's Aide	402160820419	OH

General Provider Information

NPI Number	:	1649980632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD KING

Provider Business Mailing Address
First Line	:	27030 CEDAR RD APT 501
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-1121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 E 156TH ST APT 1005
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-1104
Country	:	US
Telephone Number	:	216-246-5559
Fax Number	:

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

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	11/30/2022

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Directions to “ LEONARD KING ” Practice Location

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