Healthcare Provider Details

I. General information

NPI: 1326032871
Provider Name (Legal Business Name): LEONARD E VEKKOS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 SEVEN BRIDGES DR SUITE 290
WOODRIDGE IL
60517-1221
US

IV. Provider business mailing address

3540 SEVEN BRIDGES DR SUITE 290
WOODRIDGE IL
60517-1221
US

V. Phone/Fax

Practice location:
  • Phone: 630-852-8522
  • Fax: 630-852-8556
Mailing address:
  • Phone: 630-852-8522
  • Fax: 630-852-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016-003413
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: