Provider Demographics
NPI:1861627499
Name:LEITL, JESSICA D (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:LEITL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6002
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61803-6002
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-326-2856
Practice Address - Street 1:7600 W QUINCY AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2403
Practice Address - Country:US
Practice Address - Phone:720-449-8062
Practice Address - Fax:303-973-1050
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN11014869A207Q00000X
FLME174561207Q00000X
CODR.0057769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3270655Medicare PIN