Provider Demographics
NPI:1649296930
Name:PEEPLES, LEONE LISA
Entity type:Individual
Prefix:
First Name:LEONE
Middle Name:LISA
Last Name:PEEPLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 NORWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4911
Mailing Address - Country:US
Mailing Address - Phone:216-952-6953
Mailing Address - Fax:216-283-6288
Practice Address - Street 1:3461 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SHAKER HTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5260
Practice Address - Country:US
Practice Address - Phone:216-561-3303
Practice Address - Fax:216-561-7790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2700-P213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0701591Medicare UPIN