Basic Information
Provider Information
NPI: 1811218738
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEIBOVICI
FirstName: ADRIANA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 19402 KNOWLTON PKWY
Address2: APT 205
City: STRONGSVILLE
State: OH
PostalCode: 441499064
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2351 E 22ND ST
Address2: OFFICE OF GRADUATE MEDICAL EDUCATION
City: CLEVELAND
State: OH
PostalCode: 441153111
CountryCode: US
TelephoneNumber: 2168616200
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/15/2010
LastUpdateDate: 06/15/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X57014292OHY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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