Healthcare Provider Details

I. General information

NPI: 1497762934
Provider Name (Legal Business Name): LEIGH HAMPTON ROBERTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEJIRA HEALTHCARE 3000 N. HALSTED ST. SUITE 723
CHICAGO IL
60657-2010
US

IV. Provider business mailing address

HEJIRA HEALTHCARE 3000 N. HALSTED ST. SUITE 723
CHICAGO IL
60657-2010
US

V. Phone/Fax

Practice location:
  • Phone: 773-883-0723
  • Fax: 773-883-0724
Mailing address:
  • Phone: 773-883-0723
  • Fax: 773-883-0724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036089445
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: