Provider Demographics
NPI:1700858628
Name:S.M.LEU MD INC
Entity Type:Organization
Organization Name:S.M.LEU MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-527-2617
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-0294
Mailing Address - Country:US
Mailing Address - Phone:330-527-2617
Mailing Address - Fax:330-527-5099
Practice Address - Street 1:8307 WINDHAM ST
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-9406
Practice Address - Country:US
Practice Address - Phone:330-527-2617
Practice Address - Fax:330-527-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35100013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0266706Medicaid
OH0266706Medicaid
OHLE0406961Medicare ID - Type Unspecified