Provider Demographics
NPI:1679528681
Name:RICHARD A. LEVY, MD LTD.
Entity Type:Organization
Organization Name:RICHARD A. LEVY, MD LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-942-8989
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-0099
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 328
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-8989
Practice Address - Fax:312-942-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0725062080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31602670OtherBLUE SHIELD PROVIDER
IL31602670OtherBCBSIL GROUP #
IL31602670OtherBLUE SHIELD PROVIDER
IL460003596Medicare PIN
IL460003597Medicare PIN
IL201711Medicare PIN
IL786500Medicare PIN
IL460003598Medicare PIN