Provider Demographics
NPI:1811641129
Name:LEEVER, GRANT EDWIN
Entity type:Individual
Prefix:MR
First Name:GRANT
Middle Name:EDWIN
Last Name:LEEVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 W BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-2821
Mailing Address - Country:US
Mailing Address - Phone:513-833-1405
Mailing Address - Fax:
Practice Address - Street 1:3699 PARAGON DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9751
Practice Address - Country:US
Practice Address - Phone:614-751-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH188484146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic