Provider Demographics
NPI:1609147859
Name:YAMAMOTO, LESLIE T (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:T
Last Name:YAMAMOTO
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 1:4491 SAINT TROPEZ DR
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1039
Mailing Address - Country:US
Mailing Address - Phone:630-961-3505
Mailing Address - Fax:215-995-9645
Practice Address - Street 1:4491 SAINT TROPEZ DR
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1039
Practice Address - Country:US
Practice Address - Phone:630-961-3505
Practice Address - Fax:215-995-9645
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063057207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45052Medicare UPIN