Provider Demographics
NPI:1932387370
Name:LEONARD R. JUBERT
Entity Type:Organization
Organization Name:LEONARD R. JUBERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:JUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-776-9400
Mailing Address - Street 1:8054 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-5936
Mailing Address - Country:US
Mailing Address - Phone:773-776-9400
Mailing Address - Fax:773-776-9644
Practice Address - Street 1:8054 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5936
Practice Address - Country:US
Practice Address - Phone:773-776-9400
Practice Address - Fax:773-776-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60001709OtherBLUE CROSS BLUE SHIELD ID
IL0908640002Medicare NSC
IL60001709OtherBLUE CROSS BLUE SHIELD ID
IL920430Medicare PIN