Provider Demographics
NPI:1598840480
Name:MON, LEILANIE B (MD)
Entity Type:Individual
Prefix:
First Name:LEILANIE
Middle Name:B
Last Name:MON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEILANIE
Other - Middle Name:BELEN
Other - Last Name:MON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:708-499-3160
Mailing Address - Fax:708-499-1150
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:SUITE 312
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-499-3160
Practice Address - Fax:708-499-1150
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE30355Medicare UPIN