1932465853 NPI number — MS. LESLEY MARCUS BROWN APN, NP-C

Table of content: SATWANT KHELA MD (NPI 1134903172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932465853 NPI number — MS. LESLEY MARCUS BROWN APN, NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
LESLEY
Provider Middle Name:
MARCUS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APN, NP-C
Provider Gender Code:
F

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:
1932465853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9500 BORMET DR
Provider Second Line Business Mailing Address:
STE 204
Provider Business Mailing Address City Name:
MOKENA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60448-8399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-346-4044
Provider Business Mailing Address Fax Number:
708-346-3287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 BIESTERFIELD RD
Provider Second Line Business Practice Location Address:
SUITE # 4005
Provider Business Practice Location Address City Name:
ELK GROVE VILLAGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60007-3361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-593-4116
Provider Business Practice Location Address Fax Number:
847-593-4135
Provider Enumeration Date:
04/04/2012

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: 363LA2200X , with the licence number:  209009464 , 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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