Provider Demographics
NPI:1245206655
Name:LEV-WEISSBERG, ANDREY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREY
Middle Name:
Last Name:LEV-WEISSBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ANDREY
Other - Middle Name:
Other - Last Name:LEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4514 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1667
Mailing Address - Country:US
Mailing Address - Phone:847-675-5834
Mailing Address - Fax:847-675-5839
Practice Address - Street 1:1775 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:847-675-5834
Practice Address - Fax:847-675-5839
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine