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Individual
KEVIN ALAN LEISEBERG
Active
Individual
KEVIN ALAN LEISEBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070-011208
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0604410001
DMERC
IL
01
—
IL6237003
MEDICARE
IL
01
—
IL6238003
MEDICARE
IL
01
—
IL6697010
MEDICARE
IL
01
—
P00350919
RAILROAD MEDICARE NUMBER
IL
01
—
P01119498
RAILROAD MEDICARE
IL
Enumeration date
08/31/2006
Last updated
04/21/2016
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