Provider Demographics
NPI:1720075153
Name:DSOUZA, LEO (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:DSOUZA
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 1:325 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-1122
Mailing Address - Country:US
Mailing Address - Phone:513-207-3212
Mailing Address - Fax:513-936-8149
Practice Address - Street 1:7505 READING RD
Practice Address - Street 2:#201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3236
Practice Address - Country:US
Practice Address - Phone:513-207-3212
Practice Address - Fax:513-936-8149
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH660322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0981184Medicaid
MI0981184Medicaid
OH0765852Medicare ID - Type Unspecified
INP00201222Medicare ID - Type UnspecifiedRR MEDICARE
WV0765852Medicare ID - Type Unspecified