Provider Demographics
NPI:1922072131
Name:LEVINE, LAURENCE ADAN (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:ADAN
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON
Mailing Address - Street 2:SUITE 352
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-563-5000
Mailing Address - Fax:312-563-5007
Practice Address - Street 1:1725 W HARRISON
Practice Address - Street 2:SUITE 352
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-563-5000
Practice Address - Fax:312-563-5007
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 075314208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36075314Medicaid
IL36075314Medicaid
5514060036Medicare NSC
212210038Medicare PIN
212210Medicare PIN