Provider Demographics
NPI:1851516215
Name:LEIDEN, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:LEIDEN
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 1:196 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1355
Mailing Address - Country:US
Mailing Address - Phone:847-938-9313
Mailing Address - Fax:
Practice Address - Street 1:ABBOTT LABORATORIES
Practice Address - Street 2:100 ABBOTT PARK ROAD
Practice Address - City:ABBOTT PARK
Practice Address - State:IL
Practice Address - Zip Code:60064-6020
Practice Address - Country:US
Practice Address - Phone:847-938-9313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50631207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease