# PREMISE HEALTH OF ILLINOIS MEDICAL, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** United Airlines Onsite ORD Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518204650
- **Authorized official:** DR. JON LEIZMAN MD (PRESIDENT)
- **Authorized official phone:** (615) 468-6270

## Contact information

- **Practice address:** 11601 W TOUHY AVE, O'HARE INTERNATIONAL AIRPORT- TERMINAL 2- LOWER LEVEL, CHICAGO, IL 60666-5047
- **Practice address phone:** (770) 601-2525
- **Practice address fax:** (770) 601-2533
- **Mailing address:** 5500 MARYLAND WAY, BRENTWOOD, TN 37027-4948
- **Mailing address phone:** (888) 830-4255

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/09/2013
- **Last updated:** 08/21/2023