Clark, Leo Jp

Clark, Leo Jp is an individual health care provider with primary practice located at 5705 Monclova Rd Suite 204, Maumee OH 43537-1875. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurological Surgery, which is considered as his primary health care specialty. Clark, Leo Jp can be contacted via phone (419) 891-8045.

Contact Information

Primary practice address
5705 Monclova Rd Suite 204 Maumee OH 43537-1875
Phone: (419) 891-8045
Fax: (419) 891-8044
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurological Surgery 207T00000X 35039317C Ohio

Profile Details

NPI number 1659374007
LBN Legal business name Clark, Leo Jp
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 31st, 2005
Last updated Jan 12th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659374007 NPPES
Ohio MEDICAID 318954

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