Provider Demographics
NPI:1720515968
Name:DE CASTRO DURAES, LEONARDO (MD, PHD)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:DE CASTRO DURAES
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # A3
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-744-6009
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # A3
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0005
Practice Address - Country:US
Practice Address - Phone:216-744-6009
Practice Address - Fax:216-445-8627
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD86049208C00000X
OH35.140717208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH57027721OtherOHIO LICENSE