Individual
MR. RONALD JAY LEIB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
39 S VIRGINIA ST, CRYSTAL LAKE, IL 60014-5826
(815) 477-9221
(815) 477-8916
Mailing address
39 S VIRGINIA ST, CRYSTAL LAKE, IL 60014-5826
(815) 477-9221
(815) 477-8916
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5619947
BC BS OF ILLINOIS
IL
Enumeration date
01/24/2007
Last updated
07/09/2007
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