Individual
JACK LEYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S FIRST AVE, (FAHEY BLDG., RM. 007), MAYWOOD, IL 60153
(708) 216-3307
(708) 216-4113
Mailing address
2160 S FIRST AVE, (FAHEY BLDG., RM. 007), MAYWOOD, IL 60153
(708) 216-3307
(708) 216-4113
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
36066173
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36066173
—
IL
Enumeration date
01/13/2006
Last updated
10/10/2023
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