Provider Demographics
NPI:1437289329
Name:PLACEWAY, LESLEY ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:ANN
Last Name:PLACEWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ELM CREEK DR
Mailing Address - Street 2:APT. 118
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5267
Mailing Address - Country:US
Mailing Address - Phone:224-627-5682
Mailing Address - Fax:
Practice Address - Street 1:64 OLD ORCHARD CENTER
Practice Address - Street 2:SUITE 409
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-676-2200
Practice Address - Fax:847-676-1813
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ59530Medicare UPIN