MEDICARE: DR. SAMUEL D LEUNG D.O.

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
1	207Q00000X	Family Medicine Physician	036062409	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831227941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL D LEUNG D.O.

Provider Business Mailing Address
First Line	:	3 HILLCREST COURT
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-5757
Country	:	US
Telephone Number	:	630-986-0568
Fax Number	:	312-326-4188

Provider Business Practice Location Address
First Line	:	2142 S ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1514
Country	:	US
Telephone Number	:	312-326-1400
Fax Number	:	312-326-4188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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