Provider Demographics
NPI:1215021324
Name:TRUBOW, LESLIE NORMAN (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:NORMAN
Last Name:TRUBOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 WHISPERWOODS CT
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 WARRENVILLE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4308
Practice Address - Country:US
Practice Address - Phone:630-725-7205
Practice Address - Fax:855-210-5125
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059636208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059636Medicaid