Provider Demographics
NPI:1083660112
Name:KLABBATZ, LESLIE D (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:KLABBATZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2359
Mailing Address - Country:US
Mailing Address - Phone:330-468-5433
Mailing Address - Fax:
Practice Address - Street 1:4065 CENTER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2918
Practice Address - Country:US
Practice Address - Phone:440-816-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069253K146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH942460636157OtherCARESOURCE
OHP00283191OtherMEDICARE TRAVELERS RR-GA
OH2195002Medicaid
OH2195002Medicaid
OHP00283191OtherMEDICARE TRAVELERS RR-GA