Provider Demographics
NPI:1942274089
Name:HALL, LEO III (MD)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:HALL
Suffix:III
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:(17W740 22ND STREET, OAKBROOK TERRACE, IL 60181)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:630-627-7399
Mailing Address - Fax:630-627-7079
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(17W740 22ND STREET, OAKBROOK TERRACE, IL 60181)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:630-627-7399
Practice Address - Fax:630-627-7079
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36070077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36070077Medicaid
D38133Medicare UPIN