Healthcare Provider Details

I. General information

NPI: 1487587754
Provider Name (Legal Business Name): KATHRYN R LEVITAN ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W WELLINGTON AVE
CHICAGO IL
60657-5457
US

IV. Provider business mailing address

980 N MICHIGAN AVE STE 1090 PMB 168662 CHICAGO, ILLINOI
CHICAGO IL
60611-4521
US

V. Phone/Fax

Practice location:
  • Phone: 304-380-8691
  • Fax:
Mailing address:
  • Phone: 304-380-8691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: