Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | IL |
NPI | 1750300166 |
---|---|
Provider Name | Dr. Leslie Jay Block |
First Address | Lake Forest, IL 60045-1679 |
Second Address | Lake Forest, IL 60045-1679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C41984 | (02) | IL |