Provider Demographics
NPI:1730491465
Name:LEVICK-DOANE, LISA TOMMI (DPM)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:TOMMI
Last Name:LEVICK-DOANE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 NORTHWEST HWY STE G6
Mailing Address - Street 2:
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-1925
Mailing Address - Country:US
Mailing Address - Phone:847-639-2525
Mailing Address - Fax:847-639-2522
Practice Address - Street 1:912 NORTHWEST HWY STE G6
Practice Address - Street 2:
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1925
Practice Address - Country:US
Practice Address - Phone:847-639-2525
Practice Address - Fax:847-639-2522
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005741213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery