MEDICARE: LEONARD R. JUBERT

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	332B00000X	Durable Medical Equipment & Medical Supplies		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60001709	OTHER	IL	BLUE CROSS BLUE SHIELD ID

General Provider Information

NPI Number	:	1932387370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEONARD R. JUBERT

Provider Business Mailing Address
First Line	:	8054 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-5936
Country	:	US
Telephone Number	:	773-776-9400
Fax Number	:	773-776-9644

Provider Business Practice Location Address
First Line	:	8054 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-5936
Country	:	US
Telephone Number	:	773-776-9400
Fax Number	:	773-776-9644

Authorized Official
Title or Position	:	OWNER/PODIATRIST
Name	:	DR. LEONARD R JUBERT
Credential	:
Telephone Number	:	773-776-9400

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	02/08/2008

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Directions to “LEONARD R. JUBERT ” Practice Location

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