Provider Demographics
NPI:1992496806
Name:ALISSA BURKE LEONI, PLLC
Entity type:Organization
Organization Name:ALISSA BURKE LEONI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:BURKE
Authorized Official - Last Name:LEONI
Authorized Official - Suffix:
Authorized Official - Credentials:SW
Authorized Official - Phone:630-544-0133
Mailing Address - Street 1:2107 W BERWYN AVE APT 1W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1146
Mailing Address - Country:US
Mailing Address - Phone:630-544-0133
Mailing Address - Fax:
Practice Address - Street 1:2107 W BERWYN AVE APT 1W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1146
Practice Address - Country:US
Practice Address - Phone:630-544-0133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center