MEDICARE: GENE A LEASE 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	35-060490	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	:	1740220961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENE A LEASE MD

Provider Business Mailing Address
First Line	:	3033 KETTERING BLVD STE 100
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1948
Country	:	US
Telephone Number	:	372-932-1339
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 KETTERING BLVD STE 100
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1948
Country	:	US
Telephone Number	:	937-293-2133
Fax Number	:	255-252-2435

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	11/11/2022

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Directions to “ GENE A LEASE MD” Practice Location

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