Provider Demographics
NPI:1235279860
Name:LEVITIN, YELENA (MD)
Entity Type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:
Last Name:LEVITIN
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 1:129 W RAND RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3142
Mailing Address - Country:US
Mailing Address - Phone:847-215-0530
Mailing Address - Fax:847-215-0951
Practice Address - Street 1:129 W RAND RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3142
Practice Address - Country:US
Practice Address - Phone:847-215-0530
Practice Address - Fax:847-215-0951
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097501208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01628326OtherBCBS
IL036097501Medicaid
IL036097501Medicaid