Provider Demographics
NPI:1669432126
Name:LEONHARDT, DANNY E (MD)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:E
Last Name:LEONHARDT
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 1:1601 W SCHOOL
Mailing Address - Street 2:#413
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-880-8247
Mailing Address - Fax:773-281-4237
Practice Address - Street 1:2300 CHILDRENS PLAZA
Practice Address - Street 2:CHILDRENS MEMORIAL HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-880-8247
Practice Address - Fax:773-281-4237
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098544208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098544Medicaid
ILL96103Medicare ID - Type Unspecified
IL036098544Medicaid