Provider Demographics
NPI:1902969231
Name:RUELO, LEIGH A (PA-C)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:A
Last Name:RUELO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:A
Other - Last Name:CORRION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1786 MOON LAKE BLVD.,
Mailing Address - Street 2:SUITE #100
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1016
Mailing Address - Country:US
Mailing Address - Phone:847-882-9300
Mailing Address - Fax:847-882-9348
Practice Address - Street 1:1786 MOON LAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1016
Practice Address - Country:US
Practice Address - Phone:847-882-9300
Practice Address - Fax:847-882-9348
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002837363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical