Provider Demographics
NPI:1568451847
Name:OSORIO, LEONOR M (DO)
Entity Type:Individual
Prefix:
First Name:LEONOR
Middle Name:M
Last Name:OSORIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 NORTHCLIFF AVENUE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3272
Mailing Address - Country:US
Mailing Address - Phone:216-472-2741
Mailing Address - Fax:216-472-2739
Practice Address - Street 1:3600 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2831
Practice Address - Country:US
Practice Address - Phone:216-363-7733
Practice Address - Fax:216-631-7055
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34007712207R00000X
OH34-007712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00472854OtherRAILROAD CARE
OH352524OtherWELLCARE
OH2298777Medicaid
OHP00705970OtherRRCARE
OH4065694Medicare PIN
OHP00705970OtherRRCARE
OH4253511Medicare PIN
OH352524OtherWELLCARE
OH4065695Medicare PIN
OHH006560Medicare PIN