MEDICARE: DR. HARVEY LOUZON 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	207P00000X	Emergency Medicine Physician	036-061219	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386669703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARVEY LOUZON M.D.

Provider Business Mailing Address
First Line	:	636 CHARLEMAGNE DR
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2112
Country	:	US
Telephone Number	:	847-480-8982
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALIFORNIA AVE. AT 15TH ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1797
Country	:	US
Telephone Number	:	773-542-2000
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	11/19/2014

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