Provider Demographics
NPI:1164415329
Name:BUDDE, LEANNE S (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:S
Last Name:BUDDE
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 1:4685 FOREST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:513-853-4721
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:5520 CHEVIOT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7069
Practice Address - Country:US
Practice Address - Phone:513-451-4033
Practice Address - Fax:513-451-1356
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080295207RX0202X, 207RH0000X
IN01055053A207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64101280Medicaid
OH2552330Medicaid
IN200507970Medicaid
OH4153521Medicare ID - Type Unspecified
KY64101280Medicaid
IN176760PMedicare ID - Type Unspecified