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General NPI Number Information
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NPI Number | 1164067054
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Entity Type | Organization
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Legal Business Name | LEAGUE CORP.
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 515 N STATE ST FL 8
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City | CHICAGO
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State | IL
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Zip | 60654-9102
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Country | US
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Telephone | 312-967-2889
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Fax |
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Provider Business Mailing Address
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Address Line | 515 N STATE ST FL 8
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City | CHICAGO
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State | IL
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Zip | 60654-9102
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Country | US
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Telephone | 312-967-2889
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | MR. MUNEEB AHMED YUSUF
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Credential | B.SC, MBA, JD
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Telephone | 416-477-2554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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