Provider Demographics
NPI:1982653432
Name:STRACK, LEANNE K (DO)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:K
Last Name:STRACK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 HAYES AVE BLDG F
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7256
Mailing Address - Country:US
Mailing Address - Phone:419-626-1331
Mailing Address - Fax:419-626-1338
Practice Address - Street 1:2800 HAYES AVE
Practice Address - Street 2:BLDG G
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7248
Practice Address - Country:US
Practice Address - Phone:419-609-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008329207R00000X, 207RC0200X, 207RP1001X
IN02006226A207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2618386Medicaid
OHLICENSEOther34008329
OHLICENSEOther34008329
OH2618386Medicaid