Provider Demographics
NPI:1023464930
Name:HARRIS, LESLIE MANESS (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MANESS
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:DIANE
Other - Last Name:MANESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1725 W HARRISON ST STE 710
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3863
Mailing Address - Country:US
Mailing Address - Phone:312-942-3034
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 710
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3863
Practice Address - Country:US
Practice Address - Phone:312-942-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63978208000000X
IL036164036208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics