Provider Demographics
NPI:1548386956
Name:JOHN LENO, M.D. S.C.
Entity Type:Organization
Organization Name:JOHN LENO, M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:LENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACOG
Authorized Official - Phone:309-944-0245
Mailing Address - Street 1:9821 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-3515
Mailing Address - Country:US
Mailing Address - Phone:309-269-3280
Mailing Address - Fax:
Practice Address - Street 1:600 N COLLEGE AVE STE 210
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1093
Practice Address - Country:US
Practice Address - Phone:309-944-0245
Practice Address - Fax:309-944-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36101226174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03732008OtherBLUE CROSS BLUE SHIELD
ILB54531Medicare UPIN
IL204264Medicare ID - Type Unspecified