Healthcare Provider Details

I. General information

NPI: 1598225559
Provider Name (Legal Business Name): DANIEL LEVINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE
EVANSTON IL
60201-1700
US

IV. Provider business mailing address

4901 SEARLE PKWY STE 150
SKOKIE IL
60077-5320
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2114
  • Fax: 847-570-1223
Mailing address:
  • Phone: 847-982-3363
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036164851
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: