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NPI Code Detail

MEDICARE: DR. ANGEL DEMETRESS LEAKE M.D.

MEDICARE: DR. ANGEL DEMETRESS LEAKE M.D.
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
1207RI0200XInfectious Disease Physician036113650IL

General Provider Information

NPI Number : 1679729842
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGEL DEMETRESS LEAKE M.D.
Provider Business Mailing Address
First Line : 500 E 51ST ST
Second Line : DIVISION OF INFECTIOUS DISEASES--RM 7007
City : CHICAGO
State : IL
Zip : 60615-2400
Country : US
Telephone Number : 312-572-2363
Fax Number :
Provider Business Practice Location Address
First Line : 500 E 51ST ST
Second Line : DIVISION OF INFECTIOUS DISEASES--RM 7007
City : CHICAGO
State : IL
Zip : 60615-2400
Country : US
Telephone Number : 312-572-2363
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2008
Last Update Date : 02/09/2022

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