Provider Demographics
NPI:1164586616
Name:LEIDERMAN, YANNEK ISAAC (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:YANNEK
Middle Name:ISAAC
Last Name:LEIDERMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 W TAYLOR ST # MC648
Mailing Address - Street 2:UIC DEPT OF OPHTHALMOLOGY AND VISUAL SCIENCES
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7242
Mailing Address - Country:US
Mailing Address - Phone:312-413-4999
Mailing Address - Fax:
Practice Address - Street 1:1855 W TAYLOR ST # MC648
Practice Address - Street 2:UIC DEPT OF OPHTHALMOLOGY AND VISUAL SCIENCES
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7242
Practice Address - Country:US
Practice Address - Phone:312-413-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235488207W00000X
MA224712207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30209380Medicaid
MA1962590232OtherBLUE CROSS BLUE SHIELD