Provider Demographics
NPI:1265495543
Name:LEVIN, GERALD S (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:S
Last Name:LEVIN
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 1:190 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5655
Mailing Address - Country:US
Mailing Address - Phone:847-945-4575
Mailing Address - Fax:847-945-4593
Practice Address - Street 1:190 WAUKEGAN ROAD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015
Practice Address - Country:US
Practice Address - Phone:847-945-4575
Practice Address - Fax:847-945-4593
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13419Medicare UPIN