MEDICARE: DR. AYALA LEYSER PHD

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	101YM0800X	Mental Health Counselor	180003862	IL
2	261QP3300X	Pain Clinic/Center		IL

General Provider Information

NPI Number	:	1427294487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYALA LEYSER PHD

Provider Business Mailing Address
First Line	:	2251 W. ST PAUL AVE 4E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:	773-278-7422
Fax Number	:

Provider Business Practice Location Address
First Line	:	2251 W. ST PAUL AVE 4E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:	773-278-7422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	12/22/2008

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