Healthcare Provider Details

I. General information

NPI: 1477569978
Provider Name (Legal Business Name): JOHN G LEASE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NORTH HALSTED STREET SUITE 707
CHICAGO IL
60657
US

IV. Provider business mailing address

3000 NORTH HALSTED STREET SUITE 707
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 773-883-8234
  • Fax: 773-404-9718
Mailing address:
  • Phone: 773-883-8234
  • Fax: 773-404-9718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: