Provider Demographics
NPI:1760446330
Name:MCLEOD, EVAN GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:GEORGE
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2746
Mailing Address - Country:US
Mailing Address - Phone:708-424-9288
Mailing Address - Fax:708-422-9707
Practice Address - Street 1:2800 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2746
Practice Address - Country:US
Practice Address - Phone:708-424-9288
Practice Address - Fax:708-422-9707
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057437207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057437Medicaid
ILC41657Medicare UPIN
IL036057437Medicaid