Basic Information
| Provider Information | |||||||||
| NPI: | 1891904553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GO | ||||||||
| FirstName: | LEONARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 N SAINT CLAIR ST STE 18-250 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126951800 | ||||||||
| FaxNumber: | 3126954741 | ||||||||
| Practice Location | |||||||||
| Address1: | 675 N SAINT CLAIR ST STE 18-250 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126951800 | ||||||||
| FaxNumber: | 3126954741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 10/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036.120347 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 036.120347 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | BP1-0022644 | 01 | INSTITUTIONAL PERMIT | OTHER |