MEDICARE: DR. JAMES BRUCE LEVERENZ 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
1	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	35.122698	OH

General Provider Information

NPI Number	:	1891891958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES BRUCE LEVERENZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 245
Second Line	:
City	:	GATES MILLS
State	:	OH
Zip	:	44040-0245
Country	:	US
Telephone Number	:	440-804-4452
Fax Number	:	216-445-7013

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE # U10
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-1532
Country	:	US
Telephone Number	:	216-636-9467
Fax Number	:	166-362-6452

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	04/20/2022

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