1134142193 NPI number — DR. LILLIAN ROCHELLE S J DE LEON MD

Table of content: DR. LILLIAN ROCHELLE S J DE LEON MD (NPI 1134142193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134142193 NPI number — DR. LILLIAN ROCHELLE S J DE LEON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LEON
Provider First Name:
LILLIAN
Provider Middle Name:
ROCHELLE S J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE LEON
Provider Other First Name:
LILLIAN
Provider Other Middle Name:
ROCHELLE SAN JUAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1134142193
Entity Type Code:
Individual
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 LANE
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:
773-884-8066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 W 68TH ST
Provider Second Line Business Practice Location Address:
3RD FLOOR SUITE N
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:
773-884-8066
Provider Enumeration Date:
07/25/2006

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: 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)

  • Identifier: 036089949 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0360899492 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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