Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 19A13866 | IL |
Y | 213EG0000X | General Practice | 19A13866 | IL |
NPI | 1003907031 |
---|---|
Provider Name | Dr. Thomas Robert Leischner SR. |
First Address | Addison, IL 60101-2995 |
Second Address | Addison, IL 60101-2995 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |