Healthcare Provider Details

I. General information

NPI: 1346479102
Provider Name (Legal Business Name): LEROY STROMBERG III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 OAK PARK AVE MACNEAL HOSPITAL
BERWYN IL
60402
US

IV. Provider business mailing address

3249 OAK PARK AVE MACNEAL HOSPITAL
BERWYN IL
60402
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-3400
  • Fax: 708-783-3341
Mailing address:
  • Phone: 708-783-3400
  • Fax: 708-783-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-134862
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: