Provider Demographics
NPI:1053631390
Name:LEVINE GYNECOLOGY OF CHICAGO, S.C.
Entity Type:Organization
Organization Name:LEVINE GYNECOLOGY OF CHICAGO, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-771-0171
Mailing Address - Street 1:3000 N HALSTED ST STE 500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5194
Mailing Address - Country:US
Mailing Address - Phone:773-362-7565
Mailing Address - Fax:773-362-7568
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:SUITE 625
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:773-296-3450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty