Provider Demographics
NPI:1669833539
Name:JOHN STELIOS LEVENTIS
Entity Type:Organization
Organization Name:JOHN STELIOS LEVENTIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STELIOS
Authorized Official - Last Name:LEVENTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-244-4446
Mailing Address - Street 1:35 TOWER CT STE I
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5712
Mailing Address - Country:US
Mailing Address - Phone:847-244-4446
Mailing Address - Fax:847-244-4445
Practice Address - Street 1:35 TOWER CT STE I
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5712
Practice Address - Country:US
Practice Address - Phone:847-244-4446
Practice Address - Fax:847-244-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty