Provider Demographics
NPI:1558456897
Name:FREDRIC J. LEVY, M.D.,S.C.
Entity Type:Organization
Organization Name:FREDRIC J. LEVY, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-670-2590
Mailing Address - Street 1:1 E WACKER DR
Mailing Address - Street 2:SUITE 630
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-1802
Mailing Address - Country:US
Mailing Address - Phone:312-670-2590
Mailing Address - Fax:312-644-8183
Practice Address - Street 1:1 E WACKER DR
Practice Address - Street 2:SUITE 630
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-1802
Practice Address - Country:US
Practice Address - Phone:312-670-2590
Practice Address - Fax:312-644-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36467172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12700Medicare UPIN
IL475970Medicare ID - Type Unspecified