Healthcare Provider Details

I. General information

NPI: 1598794422
Provider Name (Legal Business Name): LEVY & OBRIEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LAKE COOK RD STE 119
DEERFIELD IL
60015
US

IV. Provider business mailing address

400 LAKE COOK RD STE 119
DEERFIELD IL
60015
US

V. Phone/Fax

Practice location:
  • Phone: 847-945-3850
  • Fax: 847-945-9604
Mailing address:
  • Phone: 847-945-3850
  • Fax: 847-945-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CHARLES LOREN OBRIEN III
Title or Position: PARTNER
Credential: MD
Phone: 847-945-3850