Provider Demographics
NPI:1043324254
Name:LEVIN, BARRY S (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:S
Last Name:LEVIN
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 1:915 S WAUKEGAN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2654
Mailing Address - Country:US
Mailing Address - Phone:224-516-4108
Mailing Address - Fax:224-516-4116
Practice Address - Street 1:915 S WAUKEGAN RD STE 200
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2654
Practice Address - Country:US
Practice Address - Phone:224-516-4108
Practice Address - Fax:224-516-4116
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-075027207L00000X, 207LC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C44565Medicare UPIN
L93487Medicare ID - Type Unspecified