Provider Demographics
NPI:1861653602
Name:LEUNG, DEBBIE T (PA)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:T
Last Name:LEUNG
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:9921 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3767
Mailing Address - Country:US
Mailing Address - Phone:708-499-5678
Mailing Address - Fax:708-499-5685
Practice Address - Street 1:1300 COPPERFIELD AVE
Practice Address - Street 2:SUITE 4050
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-2004
Practice Address - Country:US
Practice Address - Phone:815-723-9278
Practice Address - Fax:815-723-9819
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1068004Medicare PIN
ILIL1069004Medicare PIN