Healthcare Provider Details

I. General information

NPI: 1235233404
Provider Name (Legal Business Name): HOWARD B LEVY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 N SANDBURG TER UNIT 3002
CHICAGO IL
60610-1351
US

IV. Provider business mailing address

1560 N SANDBURG TER UNIT 3002
CHICAGO IL
60610-1351
US

V. Phone/Fax

Practice location:
  • Phone: 312-771-1127
  • Fax: 312-664-8531
Mailing address:
  • Phone: 312-771-1127
  • Fax: 312-664-8531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036042898
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: