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NPI Code Detail

MEDICARE: ACEZR LEYNES M.D.

MEDICARE: ACEZR LEYNES 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
1207Q00000XFamily Medicine Physician036112533IL

General Provider Information

NPI Number : 1689672537
Entity Type Code : Individual
Provider Name (Legal Business Name) : ACEZR LEYNES M.D.
Provider Business Mailing Address
First Line : 520 E 22ND ST
Second Line :
City : LOMBARD
State : IL
Zip : 60148-6110
Country : US
Telephone Number : 630-874-2542
Fax Number : 630-874-2642
Provider Business Practice Location Address
First Line : 3758 W CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60651-3823
Country : US
Telephone Number : 773-235-0626
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 03/22/2021

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