Provider Demographics
NPI:1740268408
Name:LEESON, MARK C (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:LEESON
Suffix:
Gender:M
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:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:614-544-6356
Mailing Address - Fax:
Practice Address - Street 1:24 MORRIS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1170
Practice Address - Country:US
Practice Address - Phone:419-347-4177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH042998207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0061878Medicaid
A80700Medicare UPIN
OH0061878Medicaid
OH1232120012Medicare NSC
OH0536218Medicare PIN
OH1232120019Medicare NSC
OH1232120011Medicare NSC