Provider Demographics
NPI:1164940813
Name:LEONARD CERULLO, MD, LTD
Entity Type:Organization
Organization Name:LEONARD CERULLO, MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CERULLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-442-0431
Mailing Address - Street 1:680 N LAKE SHORE DR STE 1428
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3461
Mailing Address - Country:US
Mailing Address - Phone:312-442-0431
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR STE 1428
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3461
Practice Address - Country:US
Practice Address - Phone:312-442-0431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty