Provider Demographics
NPI:1164432217
Name:MILLER, LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 WOOSTER RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-1570
Mailing Address - Country:US
Mailing Address - Phone:330-674-7777
Mailing Address - Fax:330-674-2084
Practice Address - Street 1:1261 WOOSTER RD
Practice Address - Street 2:SUITE 215
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-1570
Practice Address - Country:US
Practice Address - Phone:330-674-7777
Practice Address - Fax:330-674-2084
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057776208600000X
AZ16955208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0726512Medicaid
OH0627281Medicare ID - Type Unspecified
OH0726512Medicaid