Provider Demographics
NPI:1699948299
Name:REZNIK, LEONID (PA-C)
Entity type:Individual
Prefix:DR
First Name:LEONID
Middle Name:
Last Name:REZNIK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 E. HIGGINS ROAD
Mailing Address - Street 2:SUITE 113A
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173
Mailing Address - Country:US
Mailing Address - Phone:224-653-9000
Mailing Address - Fax:224-653-8459
Practice Address - Street 1:830 E. HIGGINS ROAD
Practice Address - Street 2:SUITE 113A
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173
Practice Address - Country:US
Practice Address - Phone:224-653-9000
Practice Address - Fax:224-653-8459
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003054363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant