Provider Demographics
NPI:1962489823
Name:LEONETTI, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LEONETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:MAGUIRE CENTER 1870
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-9183
Mailing Address - Fax:708-216-4834
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:MAGUIRE CENTER 1870
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-9183
Practice Address - Fax:708-216-4834
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036068084207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36068084Medicaid
D16576Medicare UPIN
IL36068084Medicaid
ILL81120Medicare ID - Type Unspecified