Individual
DR. KEITH LEITZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 N WESTMORELAND RD STE 102, LAKE FOREST, IL 60045-1687
(847) 535-6464
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8131
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
0101250055
VA
207Y00000X
Otolaryngology Physician
Primary
036149517
IL
Other
Enumeration date
08/07/2009
Last updated
06/06/2019
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