Healthcare Provider Details

I. General information

NPI: 1891921235
Provider Name (Legal Business Name): DAVID LEVI ALLISON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST STE 130
CHICAGO IL
60612
US

IV. Provider business mailing address

840 S WOOD ST STE 130
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-493-5605
  • Fax:
Mailing address:
  • Phone: 312-493-5605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036129247
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number036129247
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number036129247
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: