Individual
DEAN F. LESLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3050 MONTVALE DR STE A, SPRINGFIELD, IL 62704
(217) 726-8096
Mailing address
3050 MONTVALE DR STE A, SPRINGFIELD, IL 62704-6924
(217) 726-8096
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
2018032071
MO
2085R0202X
Diagnostic Radiology Physician
Primary
33031
KY
2085R0202X
Diagnostic Radiology Physician
36345
MN
2085R0202X
Diagnostic Radiology Physician
81149
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000062492
ANTHEM BLUE FACET
KY
05
—
00G820990
—
CA
05
—
060795401
—
TX
05
—
1055713
—
KY
05
—
200103160
—
IN
05
—
2136898
—
OH
05
—
64330319
—
KY
05
—
9097732-00
—
FL
Enumeration date
05/08/2006
Last updated
01/26/2023
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