Provider Demographics
NPI:1740220961
Name:LEASE, GENE A (MD)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:A
Last Name:LEASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 KETTERING BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1948
Mailing Address - Country:US
Mailing Address - Phone:372-932-1339
Mailing Address - Fax:
Practice Address - Street 1:3033 KETTERING BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1948
Practice Address - Country:US
Practice Address - Phone:937-293-2133
Practice Address - Fax:255-252-2435
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-060490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0873541Medicaid
OH0707313Medicare PIN
OH0873541Medicaid
OHH257440Medicare PIN
OH0707314Medicare PIN