Provider Demographics
NPI:1851874218
Name:LEITZEN, ROBERT FRANK
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANK
Last Name:LEITZEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 STATE ST
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1659
Mailing Address - Country:US
Mailing Address - Phone:815-790-3678
Mailing Address - Fax:
Practice Address - Street 1:707 STATE ST
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1659
Practice Address - Country:US
Practice Address - Phone:815-790-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG