Provider Demographics
NPI:1083719488
Name:LITVIN, JULIA (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:LITVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9669 KENTON AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1266
Mailing Address - Country:US
Mailing Address - Phone:847-677-1333
Mailing Address - Fax:847-677-1336
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:847-677-1333
Practice Address - Fax:847-677-1336
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL360640682Medicaid
IL360640682Medicaid
IL746830Medicare ID - Type Unspecified