Individual
EDYTA LEICHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 N BERTEAU AVE, ELMHURST, IL 60126-2966
(630) 833-1400
Mailing address
255 W MICHIGAN AVE, JACKSON, MI 49201-2218
(800) 516-5315
(248) 479-0652
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036121166
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036121166
STATE LICENSE
IL
Enumeration date
10/28/2008
Last updated
09/20/2024
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