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Individual

MR. COREY WAYNE LEO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1801 16TH ST, BOX 5180, GREELEY, CO 80631-5154
(970) 350-6066
(970) 350-6274
Mailing address
2607 MCDANIEL AVE, EVANSTON, IL 60201-1407
(319) 321-2575

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
85002510
IL

Other

Enumeration date
05/02/2007
Last updated
07/08/2007
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