Provider Demographics
NPI:1083616346
Name:LEVI, ROBERTO E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:E
Last Name:LEVI
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 1:5616 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-5113
Mailing Address - Country:US
Mailing Address - Phone:773-878-6233
Mailing Address - Fax:773-878-2688
Practice Address - Street 1:5616 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-5113
Practice Address - Country:US
Practice Address - Phone:773-878-6233
Practice Address - Fax:773-878-2688
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2013-01-23
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
IL036050593207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050593Medicaid
ILD10236Medicare UPIN
IL247130Medicare ID - Type UnspecifiedPROVIDER NUMBER