Provider Demographics
NPI:1700889334
Name:JANIS, LEONARD R (DPM)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:R
Last Name:JANIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 RIDGE MILL DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7458
Mailing Address - Country:US
Mailing Address - Phone:614-870-2029
Mailing Address - Fax:614-870-1692
Practice Address - Street 1:3780 RIDGE MILL DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7458
Practice Address - Country:US
Practice Address - Phone:614-870-2029
Practice Address - Fax:614-870-1692
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001643213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0213932Medicaid
OH0213932Medicaid
OHJA0383957Medicare PIN