MEDICARE: DR. RICHARD A LEVY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	036072506	IL
2	2080P0205X	Pediatric Endocrinology Physician	036-072506	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	31602670	OTHER	IL	BCBSIL GROUP #

General Provider Information

NPI Number	:	1265431381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A LEVY M.D.

Provider Business Mailing Address
First Line	:	2740 W FOSTER AVE STE 316
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3547
Country	:	US
Telephone Number	:	773-769-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 W FOSTER AVE STE 316
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3547
Country	:	US
Telephone Number	:	773-769-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	04/07/2021

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