Healthcare Provider Details

I. General information

NPI: 1245224310
Provider Name (Legal Business Name): LEIGHTON V ARCENAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ILLINI DR
SILVIS IL
61282-1804
US

IV. Provider business mailing address

1228 E RUSHOLME ST COGENT OFFICE MOB I
DAVENPORT IA
52803-2453
US

V. Phone/Fax

Practice location:
  • Phone: 309-792-9363
  • Fax:
Mailing address:
  • Phone: 563-421-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27859
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-066279
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: