Healthcare Provider Details

I. General information

NPI: 1750562187
Provider Name (Legal Business Name): 31ST STREET MEDICAL CENTER S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16750 80TH AVE SUITE B
TINLEY PARK IL
60477-3173
US

IV. Provider business mailing address

16750 80TH AVE SUITE B
TINLEY PARK IL
60477-3173
US

V. Phone/Fax

Practice location:
  • Phone: 708-429-7373
  • Fax: 708-429-7340
Mailing address:
  • Phone: 708-429-7373
  • Fax: 708-429-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHELDON ALLEN LEVINE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 708-429-7373