Provider Demographics
NPI:1184775785
Name:LEVY, WARREN (DPM)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4550
Mailing Address - Country:US
Mailing Address - Phone:312-266-6326
Mailing Address - Fax:312-266-6784
Practice Address - Street 1:530 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4550
Practice Address - Country:US
Practice Address - Phone:312-266-6326
Practice Address - Fax:312-266-6784
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003227213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003227Medicaid
IL60001225OtherBLUE CROSS BLUE SHIELD
IL4752360001Medicare NSC
IL60001225OtherBLUE CROSS BLUE SHIELD
673120Medicare ID - Type Unspecified