Healthcare Provider Details

I. General information

NPI: 1316953466
Provider Name (Legal Business Name): LESLIE ANNE CORDES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 HUDSON RD
GLENVIEW IL
60025-4322
US

IV. Provider business mailing address

780 HUDSON RD
GLENVIEW IL
60025-4322
US

V. Phone/Fax

Practice location:
  • Phone: 847-657-8348
  • Fax: 215-944-7257
Mailing address:
  • Phone: 847-657-8348
  • Fax: 215-944-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-072883
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: