1841240389 NPI number — DR. MICHAEL LEAHY OD

Table of content: DR. MICHAEL LEAHY OD (NPI 1841240389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841240389 NPI number — DR. MICHAEL LEAHY OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEAHY
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1841240389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10001 W 143RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60462-2026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-349-2600
Provider Business Mailing Address Fax Number:
708-349-2600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10001 W 143RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60462-2026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-349-2600
Provider Business Practice Location Address Fax Number:
708-349-2600
Provider Enumeration Date:
05/12/2006

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: 152W00000X , with the licence number:  046007442 , 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: 0410017674 . This is a "RR MEDICARE IND ORLAND PK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CN3870 . This is a "RR MEDICARE GROUP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0363448367 . This is a "TAX ID ORLAND PARK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1148260001 . This is a "DME/OP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 508980 . This is a "MEDICARE GROUP OL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DA8522 . This is a "RR MEDICARE GROUP OP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: T365669 . This is a "UPIN/ OL GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0410022638 . This is a "RR MEDICARE IND. OAK LAWN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0363241858 . This is a "TAX ID OAK LAWN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0618250001 . This is a "DME" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 985800 . This is a "MEDICARE GROUP/ OP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: W22602 . This is a "UPIN/GROUP OP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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