Provider Demographics
NPI:1578742227
Name:EUGENE J. VAN LEEUWEN, M.D. INC.
Entity Type:Organization
Organization Name:EUGENE J. VAN LEEUWEN, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VAN LEEUWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-961-8861
Mailing Address - Street 1:3001 HIGHLAND AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2315
Mailing Address - Country:US
Mailing Address - Phone:513-961-8861
Mailing Address - Fax:513-487-3770
Practice Address - Street 1:3001 HIGHLAND AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2315
Practice Address - Country:US
Practice Address - Phone:513-961-8861
Practice Address - Fax:513-487-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055807U174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000196583OtherANTHEM
KY640558300Medicaid
OH0744387Medicaid
OH1500842OtherEVERCARE
OH1500842OtherEVERCARE
OH=========00OtherBWC
OHSP00241Medicare PIN
OH0820042Medicare PIN