Provider Demographics
NPI:1992754840
Name:SIEDBAND, LEONARD B (MD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:B
Last Name:SIEDBAND
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 1:7900 N MILWAUKEE AVE
Mailing Address - Street 2:18
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3159
Mailing Address - Country:US
Mailing Address - Phone:847-663-9700
Mailing Address - Fax:874-663-9702
Practice Address - Street 1:7900 N MILWAUKEE AVE
Practice Address - Street 2:18
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3159
Practice Address - Country:US
Practice Address - Phone:847-663-9700
Practice Address - Fax:874-663-9702
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053030Medicaid
ILC42545Medicare UPIN
IL596750Medicare ID - Type Unspecified