1053404368 NPI number — MARGARET L LEISE PT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053404368 NPI number — MARGARET L LEISE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEISE
Provider First Name:
MARGARET
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BASDEN
Provider Other First Name:
MARGARET
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053404368
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24520 S US HIGHWAY 52 UNIT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANHATTAN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60442-7784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-242-0878
Provider Business Mailing Address Fax Number:
779-379-1300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24520 S US HIGHWAY 52 UNIT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60442-7784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-242-0878
Provider Business Practice Location Address Fax Number:
779-379-1300
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070012199 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00931599 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00852545 . This is a "MEDICARE RR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com