Provider Demographics
NPI:1063852853
Name:DITZEL FILHO, LEO FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:FERNANDO
Last Name:DITZEL FILHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 W 10TH AVE
Mailing Address - Street 2:N-1011A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1240
Mailing Address - Country:US
Mailing Address - Phone:614-293-7190
Mailing Address - Fax:614-293-4281
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:N-1011A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-7190
Practice Address - Fax:614-293-4281
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.021947207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery