Provider Demographics
NPI:1609878230
Name:BERLIN, LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:BERLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9600 GROSS POINT RD
Mailing Address - Street 2:NORTHSHORE UNIVERSITY HEALTHSYSTEM SKOKIE HOSPITAL
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1214
Mailing Address - Country:US
Mailing Address - Phone:847-933-6111
Mailing Address - Fax:847-933-6113
Practice Address - Street 1:9600 GROSS POINT RD
Practice Address - Street 2:SUITE A
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1214
Practice Address - Country:US
Practice Address - Phone:847-933-3585
Practice Address - Fax:847-677-9625
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-0367562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C40749Medicare UPIN