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General NPI Number Information
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NPI Number | 1215267067
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Entity Type | Organization
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Legal Business Name | LEON Y QUE, M.D.S.C.
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 6959 S PULASKI RD SUITE A
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City | CHICAGO
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State | IL
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Zip | 60629-4238
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Country | US
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Telephone | 773-838-1088
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Fax | 773-581-2847
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Provider Business Mailing Address
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Address Line | 6959 S PULASKI RD SUITE A
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City | CHICAGO
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State | IL
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Zip | 60629-4238
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Country | US
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Telephone | 773-838-1088
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Fax | 773-581-2847
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEON Y QUE
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Credential | M.D.
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Telephone | 773-838-1088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 36043152
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License Number State | IL
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