Provider Demographics
NPI:1982828190
Name:LEAHY, MEGAN (DPM)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LEAHY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 RAND RD STE 300
Mailing Address - Street 2:ATTN RAQUEL LEON
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2359
Mailing Address - Country:US
Mailing Address - Phone:847-324-3976
Mailing Address - Fax:
Practice Address - Street 1:2923 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7702
Practice Address - Country:US
Practice Address - Phone:773-777-9900
Practice Address - Fax:773-777-5927
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005241213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5860300017Medicare NSC
ILK 38281Medicare PIN
ILK 38280Medicare PIN