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Margo Larissa Leatherwood

Family Medicine

Allopathic & Osteopathic Physicians

9550 W 167th St Ste 200, Orland Park, IL 60467-5561

PECOS Enrollment

This provider is enrolled in PECOS as MARGO LEATHERWOOD.

Based on the most recent information from CMS, provider Margo Larissa Leatherwood is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1548898604
Provider Type
Individual
Full Name
Leatherwood, Margo Larissa
Title
Dr.
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
4/1/2020
Last Updated
10/24/2023

Contact Information

Practice Location

9550 W 167th St Ste 200, Orland Park, IL 60467-5561

(708) 873-4500

Unlisted Fax

Mailing Location

29373 Network Pl, Chicago, IL 60673-1293

(847) 390-5900

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 036-166282 Illinois
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Margo Larissa Leatherwood

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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