Individual
LEONID AYZENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
303 E. RAND RD, MOUNT PROSPECT, IL 60056-1508
(847) 537-6800
(847) 556-8847
Mailing address
303 E. RAND RD, MOUNT PROSPECT, IL 60056-1508
(847) 537-6800
(847) 556-8847
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036095153
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036095153
—
IL
01
—
1622332
BC & BS PROVIDER NUMBER
IL
01
—
364232115
TAX ID
IL
Enumeration date
10/06/2006
Last updated
12/22/2022
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