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NPI Code Detail

MEDICARE: DR. LELAND JAFFE D.P.M.

MEDICARE: DR. LELAND JAFFE D.P.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery Podiatrist2011000478MO
2213ES0131XFoot Surgery Podiatrist016005403IL

General Provider Information

NPI Number : 1265696777
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LELAND JAFFE D.P.M.
Provider Business Mailing Address
First Line : 2650 RIDGE AVE.
Second Line : SUITE 1223
City : EVANSTON
State : IL
Zip : 60201-1718
Country : US
Telephone Number : 847-570-2040
Fax Number :
Provider Business Practice Location Address
First Line : 1200 W. ALGONQUIN RD. BUILDING M
Second Line :
City : PALATINE
State : IL
Zip : 60067-7373
Country : US
Telephone Number : 847-618-0121
Fax Number : 847-618-3259
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2008
Last Update Date : 01/13/2025

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