Provider Demographics
NPI:1922284603
Name:LEVI, GABRIEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:S
Last Name:LEVI
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 1:5616 N WESTERN
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659
Mailing Address - Country:US
Mailing Address - Phone:773-878-6233
Mailing Address - Fax:773-878-2688
Practice Address - Street 1:5616 N WESTERN
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659
Practice Address - Country:US
Practice Address - Phone:773-878-6233
Practice Address - Fax:773-878-2688
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-13
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125048185207X00000X
IL036120934207X00000X
NY252857207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36120934Medicaid