Provider Demographics
NPI:1083618540
Name:LEEMHUIS, RONALD PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PAUL
Last Name:LEEMHUIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4601 BASSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1553
Mailing Address - Country:US
Mailing Address - Phone:814-456-2003
Mailing Address - Fax:814-456-4098
Practice Address - Street 1:227 W 22ND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2614
Practice Address - Country:US
Practice Address - Phone:814-456-2003
Practice Address - Fax:814-456-4098
Is Sole Proprietor?:No
Enumeration Date:2005-06-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022978-E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000778469Medicaid
PA105660OtherHIGHMARK BC/BS
PA0829053OtherTRICARE
PAB36639Medicare UPIN
PAB36639OtherHEALTH AMERICA
PA0829053OtherTRICARE