Provider Demographics
NPI:1871671248
Name:MORGAN, HERMAN LEO (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:LEO
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HERMAN
Other - Middle Name:LEO
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9133 S STONY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3512
Mailing Address - Country:US
Mailing Address - Phone:773-933-5511
Mailing Address - Fax:773-933-5589
Practice Address - Street 1:9133 S STONY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3512
Practice Address - Country:US
Practice Address - Phone:773-933-5511
Practice Address - Fax:773-933-5589
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044069207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12369Medicare UPIN