Healthcare Provider Details

I. General information

NPI: 1467849513
Provider Name (Legal Business Name): MATTHEW REIDY LEACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W. 95TH STREET, SUITE AIP
CHICAGO IL
60453-0001
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 219-677-7866
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036154712
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: