Provider Demographics
NPI:1568467793
Name:MEEKER, LESLEY ANN (MD)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:ANN
Last Name:MEEKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 ACKERMAN BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3559
Mailing Address - Country:US
Mailing Address - Phone:937-293-5080
Mailing Address - Fax:937-293-8820
Practice Address - Street 1:3080 ACKERMAN BLVD
Practice Address - Street 2:STE 300
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3559
Practice Address - Country:US
Practice Address - Phone:937-293-5080
Practice Address - Fax:937-293-8820
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-2194-M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2419387Medicaid
OH4117158Medicare PIN
OH2419387Medicaid