Basic Information
| Provider Information | |||||||||
| NPI: | 1245224310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARCENAS | ||||||||
| FirstName: | LEIGHTON | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1228 E RUSHOLME ST | ||||||||
| Address2: | COGENT OFFICE MOB I | ||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528032453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634213122 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 ILLINI DR | ||||||||
| Address2: | |||||||||
| City: | SILVIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612821804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097929363 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 07/29/2009 | ||||||||
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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 | 207R00000X | 27859 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036-066279 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | IL1240005 | 01 | IL | ILLINOIS MEDICARE | OTHER | 421060724002 | 05 | IL | MEDICAID | 8122859 | 01 | IL | ILLINOIS BC/BS | OTHER | 0080200 | 05 | IA | MEDICAID | 019489 | 01 | IA | IOWA BC/BS | OTHER | 1234733 | 01 | IA | CONTROLLED SUBSTANCE # | OTHER | 42106072439 | 01 | IA | JOHN DEERE HEALTH | OTHER | IA0139 | 01 | IA | JOHN DEERE EDI # | OTHER | AA2479649 | 01 | FEDERAL DEA# | OTHER | 067240 | 01 | IA | HEALTH ALLIANCE # | OTHER |