Individual
LEO M FARBOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
745 FLETCHER DR, SUITE 302, ELGIN, IL 60123-4747
(847) 695-6600
(847) 695-4279
Mailing address
PO BOX 1509, ELGIN, IL 60121-1509
(224) 238-4160
(847) 783-0599
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036070813
IL
2086S0129X
Vascular Surgery Physician
036070813
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036070813
—
IL
01
—
4515536
BCBS
—
Enumeration date
03/29/2006
Last updated
12/15/2021
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