MEDICARE: RAYMOND L LEUNG 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	207R00000X	Internal Medicine Physician	108735	MO
2	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1871716027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND L LEUNG M.D,

Provider Business Mailing Address
First Line	:	1578 BUCKHURST CT
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-8395
Country	:	US
Telephone Number	:	314-727-8099
Fax Number	:	314-727-6796

Provider Business Practice Location Address
First Line	:	1034 S BRENTWOOD BLVD
Second Line	:	SUITE 660
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-1223
Country	:	US
Telephone Number	:	314-727-8099
Fax Number	:	314-727-6796

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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