Provider Demographics
NPI:1275678740
Name:LEYLAND, JOHN T II (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:LEYLAND
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 ERIE CT
Mailing Address - Street 2:SUITE 4030
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2566
Mailing Address - Country:US
Mailing Address - Phone:708-386-7888
Mailing Address - Fax:708-386-2784
Practice Address - Street 1:1 ERIE CT STE 4030
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2510
Practice Address - Country:US
Practice Address - Phone:708-386-7888
Practice Address - Fax:708-386-2784
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036109177208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109177Medicaid
IL270320015Medicare PIN
IL036109177Medicaid
ILL99539Medicare PIN
IL201914009Medicare PIN
ILF400326736Medicare PIN
ILH89837Medicare UPIN