Individual
COURTNEY LEDDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 FRANKLIN AVE, NORMAL, IL 61761-3592
(309) 454-1400
Mailing address
925 SHERWOOD DR, LAKE BLUFF, IL 60044-2203
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036114585
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036114585
—
IL
Enumeration date
09/14/2006
Last updated
06/16/2022
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