Individual
GENE A LEASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3033 KETTERING BLVD STE 100, MORAINE, OH 45439-1948
(937) 293-2133
(255) 252-2435
Mailing address
3033 KETTERING BLVD STE 100, MORAINE, OH 45439-1948
(372) 932-1339
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-060490
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0873541
—
OH
Enumeration date
06/07/2006
Last updated
11/11/2022
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