Healthcare Provider Details

I. General information

NPI: 1932737707
Provider Name (Legal Business Name): JACOB LENIHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S JEFFERSON ST
CHICAGO IL
60661-5607
US

IV. Provider business mailing address

8413 CARRIAGE LN
TINLEY PARK IL
60487-2249
US

V. Phone/Fax

Practice location:
  • Phone: 312-612-5000
  • Fax:
Mailing address:
  • Phone: 773-896-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016.006037
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: