Basic Information
| Provider Information | |||||||||
| NPI: | 1770540163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEEKHA | ||||||||
| FirstName: | DEEPAK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1S161 SUMMIT AVE | ||||||||
| Address2: | |||||||||
| City: | OAKBROOK TERRACE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601813904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309328000 | ||||||||
| FaxNumber: | 6309328025 | ||||||||
| Practice Location | |||||||||
| Address1: | 5729 W CERMAK RD | ||||||||
| Address2: | |||||||||
| City: | CICERO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 608042129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086520200 | ||||||||
| FaxNumber: | 7086529001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036110801 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00423437 | 01 | IL | RAILROAD MEDICARE | OTHER | 036110801 | 05 | IL | MEDICAID | 21606805 | 01 | IL | BCBS PROVIDER ID | OTHER |