Provider Demographics
NPI:1427044437
Name:QUALLICH, LEONARD G JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:G
Last Name:QUALLICH
Suffix:JR
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 1:6707 POWERS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5455
Mailing Address - Country:US
Mailing Address - Phone:440-886-5558
Mailing Address - Fax:
Practice Address - Street 1:6707 POWERS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5455
Practice Address - Country:US
Practice Address - Phone:440-886-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-25
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH38167207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology