Provider Demographics
NPI:1770509341
Name:LEIZMAN, DEBRA S (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:LEIZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-057582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2032937Medicaid
OH0876561OtherAETNA
OHP00449350OtherRAILROAD MEDICARE
OH363756OtherWELLCARE
OH000000224231OtherUNISON
OH000000539718OtherANTHEM
OH10061410OtherRAILROAD MEDICARE
OH737705OtherBUCKEYE
OH000000539718OtherANTHEM
OHP00449350OtherRAILROAD MEDICARE
OH737705OtherBUCKEYE