Provider Demographics
NPI:1225009699
Name:LEIFER, MARK H (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:H
Last Name:LEIFER
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 1:4484 INDIAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1358
Mailing Address - Country:US
Mailing Address - Phone:419-991-1241
Mailing Address - Fax:
Practice Address - Street 1:2793 SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-1444
Practice Address - Country:US
Practice Address - Phone:419-227-8209
Practice Address - Fax:419-222-6007
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056268207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0691756Medicaid
OHA17201Medicare UPIN
OHLE0609011Medicare ID - Type Unspecified