Individual
DR. LESLIE A DEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1511 N BLACKHAWK BLVD, UNIV PRIMARY CARE CLINIC @ ROCKTON, ROCKTON, IL 61072-1513
(815) 624-2644
(815) 624-2186
Mailing address
1601 PARKVIEW AVE, CREDENTIALING S200, ROCKFORD, IL 61107-1822
(815) 395-5861
(815) 395-5575
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036090988
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036090988
STATE LICENSE
IL
01
—
336052592
CONTROLLED SUBSTANCE
IL
Enumeration date
02/22/2006
Last updated
03/07/2023
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