1811165376 NPI number — LILLIAN ROCHELLE SJ DELEON, MD PC

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 1811165376 NPI number — LILLIAN ROCHELLE SJ DELEON, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LILLIAN ROCHELLE SJ DELEON, MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811165376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 FAIRFAX LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKBROOK TERRACE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60181-5247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-884-7922
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 W 68TH ST
Provider Second Line Business Practice Location Address:
2S
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60629-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-884-7922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DELEON
Authorized Official First Name:
LILLIAN
Authorized Official Middle Name:
ROCHELLE SJ
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
773-884-7922

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036089949 , 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)





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