Provider Demographics
NPI:1770104408
Name:LEON, LOGAN KAHLEB (PA-C)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:KAHLEB
Last Name:LEON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 TOWNSHIP ROAD 1453
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9359
Mailing Address - Country:US
Mailing Address - Phone:419-908-8012
Mailing Address - Fax:
Practice Address - Street 1:17406 ROYALTON RD STE B
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-5144
Practice Address - Country:US
Practice Address - Phone:440-472-0900
Practice Address - Fax:440-472-0902
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50009402RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-14394OtherMEDICAL LICENSE