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General NPI Number Information
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NPI Number | 1699087882
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Entity Type | Individual
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Provider Name | MADONNA PAULETTA LEKAS PA
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Gender | Female
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Dates
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Enumeration Date | 07/05/2010
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 1600 TORRENCE AVE
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City | CALUMET CITY
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State | IL
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Zip | 60409-5430
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Country | US
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Telephone | 708-730-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 1956 W SCHOOL ST
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City | CHICAGO
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State | IL
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Zip | 60657-2035
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Country | US
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Telephone | 773-248-6314
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-003830
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License Number State | IL
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