Provider Demographics
NPI:1841202405
Name:LEIPOLD, LORI CHRISTINE (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:CHRISTINE
Last Name:LEIPOLD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12255 S 80TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1270
Mailing Address - Country:US
Mailing Address - Phone:708-923-7600
Mailing Address - Fax:708-923-7605
Practice Address - Street 1:12255 S 80TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1270
Practice Address - Country:US
Practice Address - Phone:708-923-7600
Practice Address - Fax:708-923-7605
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105955208M00000X
IL036-105955207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105955Medicaid
ILH69544Medicare UPIN