Provider Demographics
NPI:1770540163
Name:LEEKHA, DEEPAK (MD)
Entity type:Individual
Prefix:
First Name:DEEPAK
Middle Name:
Last Name:LEEKHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1S161 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3904
Mailing Address - Country:US
Mailing Address - Phone:630-932-8000
Mailing Address - Fax:630-932-8025
Practice Address - Street 1:5729 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2129
Practice Address - Country:US
Practice Address - Phone:708-652-0200
Practice Address - Fax:708-652-9001
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00423437OtherRAILROAD MEDICARE
IL036110801Medicaid
IL21606805OtherBCBS PROVIDER ID
IL036110801Medicaid
ILK39143Medicare PIN
IL207004Medicare PIN
IL21606805OtherBCBS PROVIDER ID
ILP00423437Medicare PIN