Provider Demographics
NPI:1003849563
Name:LEVENSTEIN, JOSEPH H (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
Last Name:LEVENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-1821
Mailing Address - Country:US
Mailing Address - Phone:815-943-5431
Mailing Address - Fax:815-943-0659
Practice Address - Street 1:901 GRANT ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-1821
Practice Address - Country:US
Practice Address - Phone:815-943-5431
Practice Address - Fax:815-943-0659
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081557207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1003849563Medicaid
ILP000760377CG6042OtherRAILROAD MEDICARE
IL036081557Medicaid
IL036081557Medicaid
ILF36002Medicare UPIN
ILP000760377CG6042OtherRAILROAD MEDICARE
IL214660022Medicare PIN