Provider Demographics
NPI:1376835496
Name:MIHATA, LEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:
Last Name:MIHATA
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 1:1640 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503
Mailing Address - Country:US
Mailing Address - Phone:937-328-2320
Mailing Address - Fax:
Practice Address - Street 1:500 CAHABA PARK CIR STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-8136
Practice Address - Country:US
Practice Address - Phone:205-848-2273
Practice Address - Fax:205-848-2275
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-08
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234585208000000X
IL036.127903208000000X
OH35097934208000000X
ALMD.34423208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053078Medicaid