Provider Demographics
NPI:1437854593
Name:LEVIN, SAMUEL JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JACOB
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:BUILDING 105 SUITE 1940
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-6200
Mailing Address - Fax:708-216-6840
Practice Address - Street 1:2160 S. FIRST AVE.
Practice Address - Street 2:BUILDING 105, SUITE 1940
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-6200
Practice Address - Fax:708-216-6840
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125.0829762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry