Organization
LEON Y QUE, M.D.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEON Y QUE M.D. (PRESIDENT)
(773) 838-1088
Entity
Organization
Contact information
Practice address
6959 S PULASKI RD, SUITE A, CHICAGO, IL 60629-4238
(773) 838-1088
(773) 581-2847
Mailing address
6959 S PULASKI RD, SUITE A, CHICAGO, IL 60629-4238
(773) 838-1088
(773) 581-2847
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
36043152
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21604003
BCBS
IL
05
—
36043152
—
IL
01
—
471670
MEDICARE PTAN
IL
Enumeration date
12/29/2009
Last updated
12/29/2009
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