Provider Demographics
NPI:1134142193
Name:DE LEON, LILLIAN ROCHELLE S J (MD)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:ROCHELLE S J
Last Name:DE LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LILLIAN
Other - Middle Name:ROCHELLE SAN JUAN
Other - Last Name:DE LEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1701 FAIRFAX LANE
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-5247
Mailing Address - Country:US
Mailing Address - Phone:773-884-7922
Mailing Address - Fax:773-884-8066
Practice Address - Street 1:2701 W 68TH ST
Practice Address - Street 2:3RD FLOOR SUITE N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1813
Practice Address - Country:US
Practice Address - Phone:773-884-7922
Practice Address - Fax:773-884-8066
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360899492Medicaid
IL036089949Medicaid
IL036089949Medicaid
IL205499Medicare PIN