Provider Demographics
NPI:1629268891
Name:TAHER, LEONARDO (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:
Last Name:TAHER
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 1:25200 CENTER RIDGE RD STE 2250
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4156
Mailing Address - Country:US
Mailing Address - Phone:440-331-4478
Mailing Address - Fax:
Practice Address - Street 1:25200 CENTER RIDGE RD STE 2250
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4156
Practice Address - Country:US
Practice Address - Phone:440-331-4478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097592207R00000X, 207RN0300X
WI50551-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1629268891Medicaid