Provider Demographics
NPI:1265853170
Name:HENIKOFF, LEO JR (MD)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:HENIKOFF
Suffix:JR
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 1:1437 W LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4013
Mailing Address - Country:US
Mailing Address - Phone:312-501-8187
Mailing Address - Fax:312-226-8187
Practice Address - Street 1:1437 W LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4013
Practice Address - Country:US
Practice Address - Phone:312-501-8187
Practice Address - Fax:312-226-8187
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.0391172080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology