Healthcare Provider Details

I. General information

NPI: 1083693493
Provider Name (Legal Business Name): STEWART JOHN LEEDHAM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 N HENDERSON ST SUITE F
GALESBURG IL
61401-2575
US

IV. Provider business mailing address

1134 N HENDERSON ST SUITE F
GALESBURG IL
61401-2575
US

V. Phone/Fax

Practice location:
  • Phone: 309-343-7665
  • Fax: 309-343-3567
Mailing address:
  • Phone: 309-343-7665
  • Fax: 309-343-3567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: