Provider Demographics
NPI:1497762934
Name:ROBERTS, LEIGH HAMPTON (MD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:HAMPTON
Last Name:ROBERTS
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:HEJIRA HEALTHCARE
Mailing Address - Street 2:3000 N. HALSTED ST. SUITE 723
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2010
Mailing Address - Country:US
Mailing Address - Phone:773-883-0723
Mailing Address - Fax:773-883-0724
Practice Address - Street 1:HEJIRA HEALTHCARE
Practice Address - Street 2:3000 N. HALSTED ST. SUITE 723
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2010
Practice Address - Country:US
Practice Address - Phone:773-883-0723
Practice Address - Fax:773-883-0724
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089445207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089445Medicaid
ILG83218Medicare UPIN
ILK36668Medicare PIN