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General NPI Number Information
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NPI Number | 1558456897
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Entity Type | Organization
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Legal Business Name | FREDRIC J. LEVY, M.D.,S.C.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 E WACKER DR SUITE 630
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City | CHICAGO
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State | IL
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Zip | 60601-1802
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Country | US
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Telephone | 312-670-2590
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Fax | 312-644-8183
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Provider Business Mailing Address
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Address Line | 1 E WACKER DR SUITE 630
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City | CHICAGO
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State | IL
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Zip | 60601-1802
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Country | US
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Telephone | 312-670-2590
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Fax | 312-644-8183
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Authorized Official
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Title or Position | PRESIDENT
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Name | FREDRIC J. LEVY
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Credential | M.D.
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Telephone | 312-670-2590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 3646717
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License Number State | IL
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