Provider Demographics
NPI:1407802739
Name:NIEHAUS, LESLIE P (DPM)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:P
Last Name:NIEHAUS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4910
Mailing Address - Country:US
Mailing Address - Phone:330-821-6438
Mailing Address - Fax:330-821-8433
Practice Address - Street 1:440 E STATE ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4910
Practice Address - Country:US
Practice Address - Phone:330-821-6438
Practice Address - Fax:330-821-8433
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001977213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0431634Medicaid
OH4719080001Medicare NSC
OH0479588Medicare UPIN
OH0431634Medicaid
OH9310922Medicare PIN