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NPI Code Detail

MEDICARE: PAUL ANTHONY LEO MD

MEDICARE: PAUL ANTHONY LEO MD
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
1207Q00000XFamily Medicine Physician036158342IL

General Provider Information

NPI Number : 1396205993
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL ANTHONY LEO MD
Provider Business Mailing Address
First Line : 4800 W CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60651-3226
Country : US
Telephone Number : 773-826-9600
Fax Number : 773-826-9601
Provider Business Practice Location Address
First Line : 4800 W CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60651-3226
Country : US
Telephone Number : 773-826-9600
Fax Number : 773-826-9601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2019
Last Update Date : 05/30/2023

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