=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053481176
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEONARD STALLINGS MD & ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 05/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5120 W JACKSON BLVD
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60644-4332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-265-4566
-----------------------------------------------------
Fax | 773-265-4576
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5128
-----------------------------------------------------
City | RIVER FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-265-4639
-----------------------------------------------------
Fax | 773-265-4576
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LEONARD STALLINGS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 773-265-4566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 036071417
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------