MEDICARE: LEON Y QUE, M.D.S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	36043152	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	471670	OTHER	IL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	21604003	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1215267067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEON Y QUE, M.D.S.C.

Provider Business Mailing Address
First Line	:	6959 S PULASKI RD
Second Line	:	SUITE A
City	:	CHICAGO
State	:	IL
Zip	:	60629-4238
Country	:	US
Telephone Number	:	773-838-1088
Fax Number	:	773-581-2847

Provider Business Practice Location Address
First Line	:	6959 S PULASKI RD
Second Line	:	SUITE A
City	:	CHICAGO
State	:	IL
Zip	:	60629-4238
Country	:	US
Telephone Number	:	773-838-1088
Fax Number	:	773-581-2847

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEON Y QUE
Credential	:	M.D.
Telephone Number	:	773-838-1088

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	12/29/2009

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Directions to “LEON Y QUE, M.D.S.C. ” Practice Location

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