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General NPI Number Information
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NPI Number | 1962607135
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Entity Type | Individual
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Provider Name | MARCIA ELISE LEIKIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 378 PARK AVE
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City | GLENCOE
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State | IL
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Zip | 60022-1586
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Country | US
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Telephone | 847-604-3930
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Fax | 847-242-0795
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Provider Business Mailing Address
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Address Line | 1125 ELMRIDGE DR
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City | GLENCOE
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State | IL
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Zip | 60022-1130
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Country | US
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Telephone | 847-835-3402
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Fax | 847-242-0795
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036095280
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036-095280
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License Number State | IL
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