Provider Demographics
NPI:1376549964
Name:HERING, LEONARD G JR (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:G
Last Name:HERING
Suffix:JR
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 1:4309 W MEDICAL CENTER DR STE B305
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8418
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:815-759-4941
Practice Address - Street 1:4309 W MEDICAL CENTER DR STE B305
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:815-759-4941
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081640207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081640OtherSTATE LICENSE
ILF32612Medicare UPIN
IL962341Medicare PIN