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NPI Code Detail

MEDICARE: ALEX J LEVERENTZ PA

MEDICARE: ALEX J LEVERENTZ PA
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
1363A00000XPhysician Assistant085004211IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1085004211OTHERILSTATE LICENSE

General Provider Information

NPI Number : 1467729897
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEX J LEVERENTZ PA
Provider Business Mailing Address
First Line : 880 W CENTRAL RD
Second Line : STE 4500
City : ARLINGTON HEIGHTS
State : IL
Zip : 60005-2388
Country : US
Telephone Number : 217-383-6792
Fax Number :
Provider Business Practice Location Address
First Line : 880 W CENTRAL RD
Second Line : STE 4500
City : ARLINGTON HEIGHTS
State : IL
Zip : 60005-2388
Country : US
Telephone Number : 217-383-6792
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2011
Last Update Date : 05/05/2021

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Directions to “ ALEX J LEVERENTZ PA” Practice Location

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