Provider Demographics
NPI:1255512745
Name:LEJEUNE, FREDERICK T
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:T
Last Name:LEJEUNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W HIGH ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4363
Mailing Address - Country:US
Mailing Address - Phone:419-998-4573
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:1001 BELLEFONTAINE AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2800
Practice Address - Country:US
Practice Address - Phone:419-998-4573
Practice Address - Fax:419-998-4586
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09792-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered