Provider Demographics
NPI:1174785133
Name:LEOPOLD, KATELYN ANN (MD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ANN
Last Name:LEOPOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 N PERRY ST STE A
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1740 N PERRY ST STE A
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1173
Practice Address - Country:US
Practice Address - Phone:419-523-0012
Practice Address - Fax:419-523-3416
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.096474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050083Medicaid
OHH011001OtherMEDICARE PIN