Provider Demographics
NPI:1023129145
Name:ELKUN, LEONARD DAVID (MD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:DAVID
Last Name:ELKUN
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 1:411 W. ONTARIO ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6945
Mailing Address - Country:US
Mailing Address - Phone:312-943-8322
Mailing Address - Fax:312-843-8323
Practice Address - Street 1:411 W. ONTARIO ST
Practice Address - Street 2:SUITE 402
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-6945
Practice Address - Country:US
Practice Address - Phone:312-943-8322
Practice Address - Fax:312-843-8323
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0411702084N0402X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021604911Medicare UPIN
IL478070Medicare ID - Type Unspecified