Provider Demographics
NPI:1447249677
Name:LEIZMAN, JONATHAN B (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:B
Last Name:LEIZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-2200
Mailing Address - Fax:
Practice Address - Street 1:17747 CHILLICOTHE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4739
Practice Address - Country:US
Practice Address - Phone:440-543-8855
Practice Address - Fax:440-543-2470
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075091L207Q00000X
OH350750912083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2191079Medicaid
OH000000210557OtherANTHEM
OH4031341Medicare PIN
OH2191079Medicaid
OH7408951Medicare PIN
OH4031347Medicare PIN
OH000000210557OtherANTHEM