Provider Demographics
NPI:1720665474
Name:MCCOOK, LESLEY-ANN GAIL DERBY (MD)
Entity type:Individual
Prefix:
First Name:LESLEY-ANN
Middle Name:GAIL DERBY
Last Name:MCCOOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LESLEY-ANN
Other - Middle Name:GAIL DERBY
Other - Last Name:BATTICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:561-548-1450
Mailing Address - Fax:561-548-1459
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:561-548-1450
Practice Address - Fax:561-548-1459
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.170844207RI0008X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program