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NPI Code Detail

MEDICARE: LESLEY-ANN GAIL DERBY MCCOOK MD

MEDICARE: LESLEY-ANN GAIL DERBY MCCOOK 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
1207RI0008XHepatology Physician036.170844IL
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1720665474
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLEY-ANN GAIL DERBY MCCOOK MD
Provider Business Mailing Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 561-548-1450
Fax Number : 561-548-1459
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 561-548-1450
Fax Number : 561-548-1459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2021
Last Update Date : 07/02/2024

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