Provider Demographics
NPI:1851503908
Name:MARIAN A. LLENADO-LEE, MD, INC.
Entity Type:Organization
Organization Name:MARIAN A. LLENADO-LEE, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LLENADO-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-395-9542
Mailing Address - Street 1:3533 SOUTHERN BLVD # 3750
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429
Mailing Address - Country:US
Mailing Address - Phone:937-395-9542
Mailing Address - Fax:
Practice Address - Street 1:3533 SOUTHERN BLVD # 3750
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-395-9542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000333555OtherANTHEM BLUE CROSS
OH000000038658OtherANTHEM BLUE CROSS AND BLU
OH0598607Medicaid
OHMA9346561OtherMEDICARE GROUP NO.
OH000000333555OtherANTHEM BLUE CROSS
OH000000038658OtherANTHEM BLUE CROSS AND BLU
OHLL0650525Medicare PIN
OH9346561Medicare PIN
OHMA9346561OtherMEDICARE GROUP NO.
OHSH4143371Medicare PIN