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John L Leibold

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NPI Number Detailed Information

Provider Information:

Name: John L Leibold
Gender: M
Provider License Number If Given: 35051749L

NPI Information:

NPI: 1336148832
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 2/20/2008

Provider Business Mailing Address:

Address: PO BOX 42468
Cincinnati, OH 45242
Phone Number: 5139658041
Fax Number: 5139658091

Provider Business Practice Location Address:

Address: 10500 MONTGOMERY RD
Cincinnati, OH 45242
Phone Number: 5139658041
Fax Number: 5139658091

Provider Taxonomy:

Primary: 2085R0202X
Secondary (if any):
State: OH

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