Healthcare Provider Details

I. General information

NPI: 1649246620
Provider Name (Legal Business Name): MICHAEL J LEONETTI D. P. M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9042 31ST ST
BROOKFIELD IL
60513-1347
US

IV. Provider business mailing address

9042 31ST ST
BROOKFIELD IL
60513-1347
US

V. Phone/Fax

Practice location:
  • Phone: 708-485-9300
  • Fax: 708-354-2822
Mailing address:
  • Phone: 708-485-9300
  • Fax: 708-354-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number16-2996
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number229
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: