Provider Demographics
NPI:1891897773
Name:MCNEILL, LELAND E (MD)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:E
Last Name:MCNEILL
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 1:506 W LINCOLN AVE
Mailing Address - Street 2:SUITES 200 A AND B
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2453
Mailing Address - Country:US
Mailing Address - Phone:217-348-8727
Mailing Address - Fax:217-345-7146
Practice Address - Street 1:506 W LINCOLN AVE
Practice Address - Street 2:SUITES 200 A AND B
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2453
Practice Address - Country:US
Practice Address - Phone:217-348-8727
Practice Address - Fax:217-345-7146
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-036335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001800008OtherBCBS
IL170260OtherPERSONAL CARE
IL036036335Medicaid
IL170260OtherPERSONAL CARE
IL001800008OtherBCBS
IL284500Medicare ID - Type UnspecifiedPROVIDER NUMBER