Provider Demographics
NPI:1245259142
Name:BEAIRD, LESLIE JM (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JM
Last Name:BEAIRD
Suffix:
Gender:F
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:PO BOX 3376
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60011-3376
Mailing Address - Country:US
Mailing Address - Phone:224-484-0183
Mailing Address - Fax:
Practice Address - Street 1:4885 HOFFMAN BLVD
Practice Address - Street 2:SUITE 407
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-3726
Practice Address - Country:US
Practice Address - Phone:224-484-0183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104353207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001617988OtherBC/BS GROUP #
IL677490Medicare ID - Type UnspecifiedGROUP #
ILH39959Medicare UPIN
ILL85454Medicare PIN
IL036104353Medicaid