Organization
PREMISE HEALTH OF ILLINOIS MEDICAL PC
Active
Other names
Premise Health Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN B LEIZMAN MD (PRESIDENT)
(216) 479-9063
Entity
Organization
Contact information
Practice address
131 S DEARBORN ST STE 1035, CHICAGO, IL 60603-5517
(312) 487-2141
(312) 577-0767
Mailing address
5500 MARYLAND WAY STE 120, BRENTWOOD, TN 37027-4993
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
02/20/2025
Last updated
02/20/2025
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