Provider Demographics
NPI:1154563724
Name:SUJATA, LEON MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:MICHAEL
Last Name:SUJATA
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 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:1425 N HUNT CLUB RD STE 301
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2639
Practice Address - Country:US
Practice Address - Phone:847-855-9152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-29
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135093207RN0300X
NC2012-01642207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology