Organization
FOOT FIRST PODIATRY CL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD JAY LEIB DPM (OWNER)
(815) 477-9221
Entity
Organization
Contact information
Practice address
39 S VIRGINIA ST, CRYSTAL LAKE, IL 60014-5826
(815) 477-9221
(815) 477-8916
Mailing address
39 S VIRGINIA ST, CRYSTAL LAKE, IL 60014-5826
(815) 477-9221
(815) 477-8916
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5619947
BC BS OF ILLINOIS
IL
Enumeration date
01/24/2007
Last updated
08/22/2020
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