Individual
ANTHONY S LEAZZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2425 FARGO BLVD, GENEVA, IL 60134-3591
(630) 232-2200
(630) 232-1940
Mailing address
2425 FARGO BLVD, GENEVA, IL 60134-3591
(360) 232-2200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036111542
IL
207QS0010X
Sports Medicine (Family Medicine) Physician
036111542
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111542
—
IL
01
—
P00433169
RAILROAD MEDICARE PTAN
IL
Enumeration date
01/09/2007
Last updated
12/20/2018
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