Provider Demographics
NPI:1578890877
Name:LEVY, NELSON LOUIS (MD, PHD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:LOUIS
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 BUTLER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3009
Mailing Address - Country:US
Mailing Address - Phone:847-295-3720
Mailing Address - Fax:
Practice Address - Street 1:245 BUTLER DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-3009
Practice Address - Country:US
Practice Address - Phone:847-295-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336.033031207K00000X, 208U00000X
IL036-069036207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH79243Medicare UPIN