Individual
LEENA GEETHA ADHIKESAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
200 E PENNSYLVANIA AVE, PEORIA, IL 61603-3089
(309) 655-7900
(309) 655-7903
Mailing address
200 E PENNSYLVANIA AVE, PEORIA, IL 61603-3089
(309) 655-7900
(309) 655-7903
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD428780
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036121503
—
IL
01
—
809840
MEDICARE GROUP PTAN
IL
01
—
CA4079
RR MEDICARE GROUP PTAN
IL
01
—
P00625598
RR MEDICARE MEMBER PTAN
IL
Enumeration date
12/13/2006
Last updated
12/13/2021
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