KENDALL DIVANTE LEONARD NPI 1245864784

NPI Information

NPI: 1245864784
Provider Name: KENDALL DIVANTE LEONARD
Classification: Contractor - 171W00000X
Entity Type: Individual
Address:
524 N ROBERTS DR APT 2B
GLENWOOD, IL
ZIP 60425
Phone: (708) 690-4333
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Kendall Divante Leonard is a contractor in Glenwood, IL. The provider is a person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering). Kendall Divante Leonard NPI is 1245864784. The provider is registered as an individual entity type and is a single specialty group.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

524 N ROBERTS DR APT 2B
GLENWOOD, IL
ZIP 60425-300
Phone: (708) 690-4333

The enumeration date for this NPI number is 2/24/2020 and was last updated on 2/24/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	171W00000X	Contractor		V00018705	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	11295611761	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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