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General NPI Number Information
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NPI Number | 1932387370
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Entity Type | Organization
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Legal Business Name | LEONARD R. JUBERT
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 8054 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60620-5936
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Country | US
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Telephone | 773-776-9400
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Fax | 773-776-9644
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Provider Business Mailing Address
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Address Line | 8054 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60620-5936
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Country | US
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Telephone | 773-776-9400
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Fax | 773-776-9644
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Authorized Official
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Title or Position | OWNER/PODIATRIST
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Name | DR. LEONARD R JUBERT
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Credential |
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Telephone | 773-776-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | IL
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