MEDICARE: DR. LESLIE ADJETEY KUMA M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	01062927A	IN
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician		IL

General Provider Information

NPI Number	:	1477691079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE ADJETEY KUMA M.D.

Provider Business Mailing Address
First Line	:	8018 S EVANS AVE APT 3W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3927
Country	:	US
Telephone Number	:	630-926-6825
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 GRANT ST STE 201
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46404-3439
Country	:	US
Telephone Number	:	219-944-0300
Fax Number	:

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

Provider Enumeration Date	:	02/03/2007
Last Update Date	:	07/08/2007

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