Active NPI
Mary Beth Leonard, M.D.
- Surgery Physician
- Berwyn, IL
National Provider Identifier
1063402048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 036-079983
- Practice address
- 3245 Grove Ave
Berwyn, IL 60402-3474 - Phone
- (708) 484-0621
- Fax
- (708) 484-0250
- NPI assigned
- Oct 21, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 036-079983 | IL | Primary |
Addresses
Primary practice location
3245 Grove Ave
Berwyn, IL 60402-3474
Mailing address
3245 Grove Ave
Berwyn, IL 60402-3474
Phone (708) 484-0621
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01619787 | Other | BCBSIL GROUP NUMBER | |
| 036079983 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-079983 | IL | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299628800000",
"number": "1063402048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3245 GROVE AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023474",
"telephone_number": "708-484-0621",
"fax_number": "708-484-0250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3245 GROVE AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023474",
"telephone_number": "708-484-0621",
"fax_number": "708-484-0250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEONARD",
"first_name": "MARY",
"middle_name": "BETH",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-21",
"last_updated": "2011-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "036-079983",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSIL GROUP NUMBER",
"identifier": "01619787",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036079983",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.