Provider Demographics
NPI:1992791636
Name:LEONE, LOUIS DOMINICK (DO)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:DOMINICK
Last Name:LEONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1165
Mailing Address - Country:US
Mailing Address - Phone:440-285-8585
Mailing Address - Fax:440-285-3754
Practice Address - Street 1:320 CENTER ST
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1165
Practice Address - Country:US
Practice Address - Phone:440-285-8585
Practice Address - Fax:440-285-3754
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4166207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH109520OtherKAISER
OH000000136043OtherUNICARE
OH0663670Medicaid
OH000000136043OtherANTHEM
OH0663670Medicaid
OH0720651Medicare PIN
OH210000019Medicare PIN