Healthcare Provider Details

I. General information

NPI: 1437355146
Provider Name (Legal Business Name): ROSS MATTHEW LEVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13450 N MERIDIAN ST SUITE 355
CARMEL IN
46032-1546
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8484
  • Fax:
Mailing address:
  • Phone: 847-570-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01063389A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: