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General NPI Number Information
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NPI Number | 1659550374
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Entity Type | Individual
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Provider Name | LEON GURVICH ANP
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Gender | Male
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 1910 LANDWEHR RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-5163
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Country | US
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Telephone | 847-529-2407
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Fax | 847-400-0881
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Provider Business Mailing Address
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Address Line | 1910 LANDWEHR RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-5163
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Country | US
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Telephone | 847-529-2407
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209006769
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License Number State | IL
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