Provider Demographics
NPI:1518924281
Name:LEONARD, LORI R (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:R
Last Name:LEONARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:KLEINSCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6751N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3903
Mailing Address - Country:US
Mailing Address - Phone:330-296-3641
Mailing Address - Fax:330-296-5297
Practice Address - Street 1:8819 COMMONS BLVD # 100
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2177
Practice Address - Country:US
Practice Address - Phone:330-425-2212
Practice Address - Fax:330-425-2779
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006358L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2065723Medicaid
OH0826365Medicare PIN