Healthcare Provider Details

I. General information

NPI: 1235160797
Provider Name (Legal Business Name): ROBERT L LEVY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LAKE COOK ROAD SUITE 119
DEERFIELD IL
60015
US

IV. Provider business mailing address

400 LAKE COOK ROAD SUITE 119
DEERFIELD IL
60015
US

V. Phone/Fax

Practice location:
  • Phone: 847-945-3850
  • Fax:
Mailing address:
  • Phone: 847-945-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3641778
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: