MEDICARE: ARCHER FAMILY MEDICAL GROUP, LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1508817727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCHER FAMILY MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	6649 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2419
Country	:	US
Telephone Number	:	773-586-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	6649 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2419
Country	:	US
Telephone Number	:	773-586-2100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID B. LEVY
Credential	:	MD
Telephone Number	:	773-586-2100

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/22/2020

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