Provider Demographics
NPI:1669551685
Name:PEPA, LEO G (MD)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:G
Last Name:PEPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:201 PENNY AVE
Mailing Address - Street 2:#200
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118
Mailing Address - Country:US
Mailing Address - Phone:847-428-0400
Mailing Address - Fax:847-428-0534
Practice Address - Street 1:201 PENNY AVE
Practice Address - Street 2:#200
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118
Practice Address - Country:US
Practice Address - Phone:847-428-0400
Practice Address - Fax:847-428-0534
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1669551685OtherNPI
IL1255484028OtherCORP. NPI
IL1669551685OtherNPI
C38248Medicare UPIN