Provider Demographics
NPI:1922081348
Name:CHAO, LEIGH CHIN (MD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:CHIN
Last Name:CHAO
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 1:1516 MERGANSER BLVD
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-8539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT ANTHONYS WAY
Practice Address - Street 2:ST. ANTHONY'S HEALTH CENTER
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4568
Practice Address - Country:US
Practice Address - Phone:618-465-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112947207P00000X
IL036.102496207P00000X
IL036102496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102496Medicaid
IL036102496-4Medicaid
MO203922026Medicaid
IL203922067Medicaid
MO203922026Medicaid
IL036102496Medicaid
MO014013210Medicare PIN
ILK06153Medicare ID - Type Unspecified
IL036102496-4Medicaid
MO017013211Medicare PIN