Provider Demographics
NPI:1255304275
Name:LEIMKUEHLER, ROBERT VINCENT (C P O)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:VINCENT
Last Name:LEIMKUEHLER
Suffix:
Gender:M
Credentials:C P O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2214
Mailing Address - Country:US
Mailing Address - Phone:216-651-7788
Mailing Address - Fax:216-651-4057
Practice Address - Street 1:5403 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2911
Practice Address - Country:US
Practice Address - Phone:440-442-0454
Practice Address - Fax:440-442-0597
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5084706Medicaid
OH5084706Medicaid