Provider Demographics
NPI:1720047822
Name:MENDEZ LEAZARD, ZORAIDA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ZORAIDA
Middle Name:A
Last Name:MENDEZ LEAZARD
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 1:601 E MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-7460
Mailing Address - Country:US
Mailing Address - Phone:913-359-6019
Mailing Address - Fax:
Practice Address - Street 1:190 N UNION ST STE 203
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1362
Practice Address - Country:US
Practice Address - Phone:913-359-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-056372207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020401300OtherFEDERAL BLACK LUNG
OH0695976Medicaid
OH000000320319OtherANTHEM
OH020401300OtherFEDERAL BLACK LUNG
OHP00063493Medicare PIN