Provider Demographics
NPI:1417113291
Name:LEONARD, HEATHER RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:RYAN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N ORCHARD ST
Mailing Address - Street 2:APT 905
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5241
Mailing Address - Country:US
Mailing Address - Phone:860-335-0094
Mailing Address - Fax:
Practice Address - Street 1:259 E ERIE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2930
Practice Address - Country:US
Practice Address - Phone:312-926-9512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAN524039426038207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAN524039426038OtherDEA NUMBER