Provider Demographics
NPI:1720150303
Name:LEONARD, DEENA F (MD)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:F
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W LAKE COOK RD STE C
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1970
Mailing Address - Country:US
Mailing Address - Phone:847-459-6060
Mailing Address - Fax:847-459-9797
Practice Address - Street 1:1120 W LAKE COOK RD STE C
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1970
Practice Address - Country:US
Practice Address - Phone:847-459-6060
Practice Address - Fax:847-459-9797
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086243207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086243Medicaid
L50975Medicare ID - Type Unspecified
ILF60640Medicare UPIN