MEDICARE: DR. JOEL R LEFF 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
1	2084P0800X	Psychiatry Physician	036-047695	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
2	21609141	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1952478919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL R LEFF M.D.

Provider Business Mailing Address
First Line	:	7350 W COLLEGE DR
Second Line	:	106
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1149
Country	:	US
Telephone Number	:	708-361-5110
Fax Number	:	708-361-5305

Provider Business Practice Location Address
First Line	:	7350 W COLLEGE DR
Second Line	:	106
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1149
Country	:	US
Telephone Number	:	708-361-5110
Fax Number	:	708-361-5305

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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