Healthcare Provider Details

I. General information

NPI: 1265431381
Provider Name (Legal Business Name): RICHARD A LEVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 W FOSTER AVE STE 316
CHICAGO IL
60625-3547
US

IV. Provider business mailing address

2740 W FOSTER AVE STE 316
CHICAGO IL
60625-3547
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-9200
  • Fax:
Mailing address:
  • Phone: 773-769-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036072506
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number036-072506
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: