Provider Demographics
NPI:1003084112
Name:SOUTH LOOP URGENT CARE, LLC
Entity Type:Organization
Organization Name:SOUTH LOOP URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-663-3522
Mailing Address - Street 1:1430 S MICHIGAN AVE
Mailing Address - Street 2:C2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2960
Mailing Address - Country:US
Mailing Address - Phone:312-663-3522
Mailing Address - Fax:
Practice Address - Street 1:1430 S MICHIGAN AVE
Practice Address - Street 2:C2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2960
Practice Address - Country:US
Practice Address - Phone:312-663-3522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108576261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care