Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 036.039117 | IL |
NPI | 1265853170 |
---|---|
Provider Name | Dr. Leo Henikoff JR. |
First Address | Chicago, IL 60607-4013 |
Second Address | Chicago, IL 60607-4013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2013 |
Last Update Date | 18/12/2013 |