Individual
LEONARD R JUBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8054 S WESTERN AVE, CHICAGO, IL 60620-5936
(773) 776-9400
(773) 776-9644
Mailing address
8054 S WESTERN AVE, CHICAGO, IL 60620-5936
(773) 776-9400
(773) 776-9644
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004432
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004432
—
IL
01
—
60001709
BLUE CROSS ID NUMBER
IL
Enumeration date
07/06/2006
Last updated
04/22/2008
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