Provider Demographics
NPI:1750300166
Name:BLOCK, LESLIE JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JAY
Last Name:BLOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:700 N WESTMORELAND RD
Mailing Address - Street 2:BLD F
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1679
Mailing Address - Country:US
Mailing Address - Phone:847-295-1114
Mailing Address - Fax:847-295-9373
Practice Address - Street 1:700 N WESTMORELAND RD
Practice Address - Street 2:BLD F
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1679
Practice Address - Country:US
Practice Address - Phone:847-295-1114
Practice Address - Fax:847-295-9373
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IL207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC41984Medicare UPIN