Provider Demographics
NPI:1194702068
Name:VERTUNO, LEONARD L (MD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:L
Last Name:VERTUNO
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 1:2160 S FIRST AVE
Mailing Address - Street 2:(LUH-NORTH ENT., RM. 7604)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-3306
Mailing Address - Fax:708-216-1259
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(LUH-NORTH ENT., RM. 7604)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-3306
Practice Address - Fax:708-216-1259
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36042110207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL493440Medicare ID - Type Unspecified
D13168Medicare UPIN
ILL80225Medicare ID - Type Unspecified