Basic Information
| Provider Information | |||||||||
| NPI: | 1114217411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEONG | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 N MICHIGAN AVE UNIT 907 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606024885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086236816 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1611 W HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606124861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776326637 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2011 | ||||||||
| LastUpdateDate: | 04/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | A124051 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | PENDING | MD | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | PENDING | MD | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | 036142609 | IL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.