Provider Demographics
NPI:1841276201
Name:VERHAGEN METMAN, LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:VERHAGEN METMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON
Mailing Address - Street 2:#755 UNIVERSITY NEUROLOGISTS SECT OF MOVEMENT DISORDERS
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3824
Mailing Address - Country:US
Mailing Address - Phone:312-563-2900
Mailing Address - Fax:312-563-2024
Practice Address - Street 1:1725 W HARRISON
Practice Address - Street 2:#755 NEUROSCIENCE INSTITUTE SECT OF MOVEMENT DISORDERS
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3824
Practice Address - Country:US
Practice Address - Phone:312-563-2030
Practice Address - Fax:312-563-2684
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361003992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336061919OtherCS IL DEPT OF PROF REG
IL036100399Medicaid
BV6572437OtherDEA DEPT OF JUSTICE
BV6572437OtherDEA DEPT OF JUSTICE
ILL73468Medicare ID - Type Unspecified