Healthcare Provider Details

I. General information

NPI: 1467361584
Provider Name (Legal Business Name): LEAH R EISENBERG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST STE 1400
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

1740 W. TAYLOR ST. STE 1400 MC 693
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-3805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: