Healthcare Provider Details

I. General information

NPI: 1841312980
Provider Name (Legal Business Name): JOEL S. LEIFHEIT M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 WEST ST SUITE 111
PERU IL
61354-2763
US

IV. Provider business mailing address

920 WEST ST SUITE 111
PERU IL
61354-2763
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-4273
  • Fax: 815-223-4328
Mailing address:
  • Phone: 815-223-4273
  • Fax: 815-223-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: JOEL S LEIFHEIT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 815-223-4273