Provider Demographics
NPI:1417991621
Name:LEVIN, MARC R (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:R
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:9933 LAWLER AVE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3703
Mailing Address - Country:US
Mailing Address - Phone:847-677-0780
Mailing Address - Fax:847-677-0781
Practice Address - Street 1:9933 LAWLER AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3703
Practice Address - Country:US
Practice Address - Phone:847-677-0780
Practice Address - Fax:847-677-0781
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036058062207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058062Medicaid
ILK52441OtherMEDICARE
IL036058062Medicaid