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Organization

LEONARD R. JUBERT

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LEONARD R JUBERT (OWNER/PODIATRIST)
(773) 776-9400
Entity
Organization

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
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
60001709
BLUE CROSS BLUE SHIELD ID
IL
Enumeration date
02/07/2008
Last updated
02/08/2008
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