Healthcare Provider Details

I. General information

NPI: 1699890483
Provider Name (Legal Business Name): COMFORTLINK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD
WINFIELD IL
60190
US

IV. Provider business mailing address

7734 JOLIET DR S
TINLEY PARK IL
60477-4573
US

V. Phone/Fax

Practice location:
  • Phone: 630-682-1600
  • Fax:
Mailing address:
  • Phone: 630-645-9900
  • Fax: 630-645-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: ILEANA MARIA LEYVA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-645-9900