Healthcare Provider Details

I. General information

NPI: 1235147257
Provider Name (Legal Business Name): MICHAEL S LEININGER PA PHYSICIAN ASST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N MADISON ST
JOLIET IL
60435
US

IV. Provider business mailing address

2650 WARRENVILLE RD SUITE 280
DOWNERS GROVE IL
60515
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-7133
  • Fax: 815-773-7859
Mailing address:
  • Phone: 630-324-7911
  • Fax: 630-324-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085002266
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: