Provider Demographics
NPI:1003912908
Name:LEON J FRAZIN, M.D.
Entity Type:Organization
Organization Name:LEON J FRAZIN, M.D.
Other - Org Name:LEON J FRAZIN, M.D., S.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRAZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-635-6490
Mailing Address - Street 1:241 GOLF MILL CTR
Mailing Address - Street 2:STE 728
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1224
Mailing Address - Country:US
Mailing Address - Phone:847-635-6490
Mailing Address - Fax:847-635-6491
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:STE 250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-276-0988
Practice Address - Fax:773-276-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL476220Medicare ID - Type Unspecified