Keith P Leitzen (NPI# 1174754139, PAC ID# 4183854235) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OTOLARYNGOLOGY.
| Nation Provider ID (NPI) | 1174754139 |
| PAC ID by PECOS | 4183854235 |
| Professional Enrollment ID | I20190619001267 |
| Full Name | Keith P Leitzen |
| Organization Legal Name | NORTHWESTERN MEDICAL FACULTY FOUNDATION |
| Address |
800 N W Moreland Rd Suite 102 Lake Forest IL 60045-1687 |
| Phone Number | 8475822104 |
| Gender | M |
| Medical School | UNIVERSITY OF MINNESOTA MEDICAL SCHOOL |
| Graduation Year | 2009 |
| Primary Specialty | OTOLARYNGOLOGY |
| Group Practice PAC ID | 4587576814 |
| Number of Group Practice Members | 2103 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140130 | NORTHWESTERN LAKE FOREST HOSPITAL |
| 140281 | NORTHWESTERN MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 800 N W Moreland Rd, Suite 102, Lake Forest, IL 60045-1687 | 8475822104 | NORTHWESTERN MEDICAL FACULTY FOUNDATION |
| Organization Legal Name | NORTHWESTERN MEDICAL FACULTY FOUNDATION |
| Physicians | 2248 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michelle A Young | Registered Dietitian Or Nutrition Professional | Northwestern Medical Faculty Foundation | 800 N Westmoreland Rd, Suite 201, Lake Forest, IL 60045-1687 |
| Guadalupe Rodriguez | Nurse Practitioner | Northwestern Medical Faculty Foundation | 350 S Waukegan, Suite 150, Deerfield, IL 60015-5239 |
| Walter J Liszewski | Dermatology | Northwestern Medical Faculty Foundation | 676 N St Clair, 1600 Dept of Dermatology, Chicago, IL 60611-2997 |
| Joshua G Cahan | Neurology | Northwestern Medical Faculty Foundation | 675 N Saint Clair St, Suite 20 100, Chicago, IL 60611-5970 |
| Jennifer Lee | Ophthalmology | Northwestern Medical Faculty Foundation | 259 E Erie, Lavin 1520, Chicago, IL 60611-2987 |
| David S Burstein | Internal Medicine | Northwestern Medical Faculty Foundation | 676 N Saint Clair, Chicago, IL 60611-2927 |
| Richard R Clark | Family Medicine | Northwestern Medical Faculty Foundation | 1475 E Belvidere Rd, Pavilion C Suite 385, Grayslake, IL 60030-2026 |
| Edward J Tanner Iii | Gynecological Oncology | Northwestern Medical Faculty Foundation | 250 E Superior, 2304 Nwmff Prent Wmn Hosp, Chicago, IL 60611-2914 |
| Katie Marie Reidy | Physician Assistant | Northwestern Medical Faculty Foundation | 350 S Waukegan Rd, Deerfield, IL 60015-5239 |
| Krista Puckett | Nurse Practitioner | Northwestern Medical Faculty Foundation | 635 N Fairbanks Ct, Fl 1, Chicago, IL 60611-5435 |
| Street Address |
800 N W MORELAND RD SUITE 102 |
| City | LAKE FOREST |
| State | IL |
| Zip | 60045-1687 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jason C Rho | Pulmonary Disease | Northwestern Medical Faculty Foundation | 800 N W Moreland Rd, Suite 102, Lake Forest, IL 60045-1687 |
| Mary Maish | Thoracic Surgery | Northwestern Medical Faculty Foundation | 800 N W Moreland Rd, Suite 102, Lake Forest, IL 60045-1687 |
| Frank S Becker | Pulmonary Disease | Northwestern Medical Faculty Foundation | 800 N W Moreland Rd, Suite 102, Lake Forest, IL 60045-1687 |
| Jessica Elliott | Qualified Audiologist | Northwestern Medical Faculty Foundation | 800 N W Moreland Rd, Suite 102, Lake Forest, IL 60045-1687 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mohamed M Bayoumi | Hospitalist | Northwestern Medical Faculty Foundation | 1000 N Westmoreland Rd, Pavillion B 3rd Fl, Lake Forest, IL 60045-1659 |
| John Lee | Pathology | Consolidated Pathology Consultants Sc | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 |
| Tanner L Colegrove | Obstetrics/gynecology | Northwestern Medical Faculty Foundation | 1000 Westmoreland Rd, Lake Forest, IL 60045-1659 |
| Vikram K Devisetty | Hospitalist | Northwestern Medical Faculty Foundation | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 |
| Jennifer Nguyen | Hospitalist | Northwestern Medical Faculty Foundation | 1000 Westmoreland Rd, Lake Forest, IL 60045-1659 |
| Katie Konopacz | Nurse Practitioner | Northwestern Medical Faculty Foundation | 1000 Westmoreland Rd, Lake Forest, IL 60045-1659 |
| Albert A Nemcek Jr. | Interventional Radiology | Northwestern Medical Faculty Foundation | 1000 Westmoreland Rd, Lake Forest, IL 60045-1659 |
| Kaitlin E Hayes | Physician Assistant | Northwestern Medical Faculty Foundation | 1000 Westmoreland Rd, Lake Forest, IL 60045-1659 |
| Melissa M Auger | Obstetrics/gynecology | Northwestern Medical Faculty Foundation | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 |
| Cynthia H Leaker | Nurse Practitioner | Northwestern Medical Faculty Foundation | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 |
| Find all physicians in zip 60045 | |||
| City | LAKE FOREST |
| Zip Code | 60045 |
| Specialty | OTOLARYNGOLOGY |
| City + Specialty | LAKE FOREST + OTOLARYNGOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.