Provider Demographics
NPI:1679598742
Name:LEIKIN, JERROLD B (MD)
Entity type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:B
Last Name:LEIKIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:ENH OMEGA/MEDICAL TOXICOLOGY
Mailing Address - Street 2:2150 PFINGSTEN ROAD, SUITE 3000
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026
Mailing Address - Country:US
Mailing Address - Phone:847-657-1700
Mailing Address - Fax:847-657-1715
Practice Address - Street 1:ENH OMEGA/MEDICAL TOXICOLOGY
Practice Address - Street 2:2150 PFINGSTEN ROAD, SUITE 3000
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026
Practice Address - Country:US
Practice Address - Phone:847-657-1700
Practice Address - Fax:847-657-1715
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-062756207P00000X, 207R00000X
IL336-027292207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45225Medicare UPIN