Provider Demographics
NPI:1104984632
Name:LEYA, FERDINAND S (MD)
Entity type:Individual
Prefix:
First Name:FERDINAND
Middle Name:S
Last Name:LEYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:LUH-TOWER ENTER., ROOM 6210
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-4225
Mailing Address - Fax:708-216-8795
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:LUH-TOWER ENTER., ROOM 6210
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-4225
Practice Address - Fax:708-216-8795
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036059294207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G31710Medicare UPIN