| Jack C Leong Md Sc | |
|
3000 N Cicero Ave Chicago IL 60641-5106 | |
| (773) 282-3115 | |
| (773) 282-0590 |
| Full Name | Jack C Leong Md Sc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3000 N Cicero Ave, Chicago, Illinois |
| Authorized Official Name and Position | Jack C Leong (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7732823115 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack C Leong Md Sc 3000 N Cicero Ave Chicago IL 60641-5106 Ph: (773) 282-3115 | Jack C Leong Md Sc 3000 N Cicero Ave Chicago IL 60641-5106 Ph: (773) 282-3115 |
| NPI Number | 1437357480 |
|---|---|
| Provider Enumeration Date | 07/10/2007 |
| Last Update Date | 10/20/2020 |
| Medicare PECOS PAC ID | 3577620855 |
|---|---|
| Medicare Enrollment ID | O20090401000314 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437357480 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 036070436 (Illinois) | Primary |
| Provider Name | Jack C Leong |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1174506513 PECOS PAC ID: 2062416381 Enrollment ID: I20090401000309 |
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