Provider Demographics
NPI:1255358115
Name:KHAITAN, LEENA (MD)
Entity type:Individual
Prefix:
First Name:LEENA
Middle Name:
Last Name:KHAITAN
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
Practice Address - Country:US
Practice Address - Phone:216-844-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051958208600000X
OH35-089052208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1977496OtherUNITED HEALTHCARE
GA2966206OtherUS HEALTHCARE
GA020052913OtherRAILROAD MEDICARE
OH7867137OtherAETNA
OH000000221319OtherUNISON
747193OtherBUCKEYE
OH000000221319OtherUNISUN
GA841282OtherBCBS
GAY 20030101OtherPHCS
GA000962838AMedicaid
OH2707075Medicaid
OH000000506287OtherANTHEM
OH414991OtherWELLCARE
OH2707075Medicaid
OH414991OtherWELLCARE
OH7867137OtherAETNA
GA1977496OtherUNITED HEALTHCARE
OHKH4199964Medicare PIN