Provider Information for 1841064250
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KENNETH JAMES LEGGIN
Sex: Male
NPI: 1841064250
Last Updated: 2023-11-07
Certification Date: 2023-11-07
Certification Date: 2023-11-07
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1841064250 | ||||||||
| Enumeration Date | 2023-11-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1046 EASTERN AVE BELLWOOD, IL 60104-2413 United States Phone: 630-643-6615 | Fax: | ||||||||
| Primary Practice Address | 1046 EASTERN AVE BELLWOOD, IL 60104-2413 United States Phone: 630-643-6615 | Fax: | ||||||||
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