Provider Demographics
NPI:1700981479
Name:LEFOER, DOMINIC S (MD)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:S
Last Name:LEFOER
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 1:8018 MEADOWBROOKE TRL
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-5326
Mailing Address - Country:US
Mailing Address - Phone:330-707-0939
Mailing Address - Fax:
Practice Address - Street 1:9318 STATE ROUTE 14
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5224
Practice Address - Country:US
Practice Address - Phone:330-626-3111
Practice Address - Fax:330-626-5978
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-067754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2190696Medicaid
OH2190696Medicaid
OHG63902Medicare UPIN