Provider Demographics
NPI:1003059684
Name:MUTHURI, LEAH WANGECI (MD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:WANGECI
Last Name:MUTHURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:WANGECI
Other - Last Name:NDEGWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:625 AFRICA RD STE 240
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9808
Mailing Address - Country:US
Mailing Address - Phone:614-508-2672
Mailing Address - Fax:614-508-2668
Practice Address - Street 1:625 AFRICA RD STE 240
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9808
Practice Address - Country:US
Practice Address - Phone:614-508-2672
Practice Address - Fax:614-508-2668
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35126504207R00000X
KY42700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0140176Medicaid
KY0795669Medicare PIN
KY0637777Medicare PIN
KY00640027Medicare PIN
KY01021014Medicare PIN
KY00714068Medicare PIN
KY01065012Medicare PIN
KY01022011Medicare PIN