Provider Demographics
NPI:1891206553
Name:LEANONME GROUP LLC
Entity Type:Organization
Organization Name:LEANONME GROUP LLC
Other - Org Name:LEANONME MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-299-0145
Mailing Address - Street 1:5002 CHARISMA DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-8843
Mailing Address - Country:US
Mailing Address - Phone:972-299-0145
Mailing Address - Fax:
Practice Address - Street 1:5002 CHARISMA DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-8843
Practice Address - Country:US
Practice Address - Phone:972-299-0145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty