Provider Demographics
NPI:1881635860
Name:LINDBERG, LESLIE E (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:E
Last Name:LINDBERG
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 1:641 E GRANT ST
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1812
Mailing Address - Country:US
Mailing Address - Phone:815-432-4790
Mailing Address - Fax:815-432-5059
Practice Address - Street 1:1801 N STATE ROUTE 1
Practice Address - Street 2:BUILDING 3 SUITE 1
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-7703
Practice Address - Country:US
Practice Address - Phone:815-432-0100
Practice Address - Fax:815-432-0900
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-036-7202085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212260Medicare ID - Type Unspecified