Individual
NADINE KIM LEBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3249 OAK PARK AVE, BERWYN, IL 60402-3429
(708) 783-2696
(708) 783-3164
Mailing address
3249 SOUTH OAK PARK AVE., BERWYN, IL 60402
(708) 783-2696
(708) 783-3164
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
036-97906
IL
2085R0202X
Diagnostic Radiology Physician
036-097906
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036097906
—
IL
01
—
300113436
RR MEDICARE
IL
Enumeration date
06/05/2006
Last updated
05/23/2022
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