Provider Demographics
NPI:1891781811
Name:LEDER, WILFRIED (MD)
Entity type:Individual
Prefix:
First Name:WILFRIED
Middle Name:
Last Name:LEDER
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 1:2727 MADISON RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2276
Mailing Address - Country:US
Mailing Address - Phone:513-321-4333
Mailing Address - Fax:513-533-6033
Practice Address - Street 1:2727 MADISON RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-2276
Practice Address - Country:US
Practice Address - Phone:513-321-4333
Practice Address - Fax:513-533-6033
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH32667207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0179462Medicaid
OHLE0372622Medicare ID - Type UnspecifiedOHIO MEDICARE
OH0179462Medicaid