Provider Demographics
NPI:1518175348
Name:NORTHWEST ENT, INC.
Entity Type:Organization
Organization Name:NORTHWEST ENT, INC.
Other - Org Name:FRED R. LEESS, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-578-4300
Mailing Address - Street 1:498 LONDON AVE
Mailing Address - Street 2:STE. G
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-5512
Mailing Address - Country:US
Mailing Address - Phone:937-578-4300
Mailing Address - Fax:937-578-4311
Practice Address - Street 1:498 LONDON AVE
Practice Address - Street 2:STE. G
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-5512
Practice Address - Country:US
Practice Address - Phone:937-578-4300
Practice Address - Fax:937-578-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083442L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty