Provider Demographics
NPI:1902931504
Name:LEONARDO T QUE MD INC
Entity Type:Organization
Organization Name:LEONARDO T QUE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:T
Authorized Official - Last Name:QUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-734-4539
Mailing Address - Street 1:602 E 6TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2065
Mailing Address - Country:US
Mailing Address - Phone:419-734-4539
Mailing Address - Fax:419-734-6365
Practice Address - Street 1:602 E 6TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2065
Practice Address - Country:US
Practice Address - Phone:419-734-4539
Practice Address - Fax:419-734-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-0504207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty