Provider Demographics
NPI:1255433728
Name:LEVY, MARK H (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:60 AVON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1327
Mailing Address - Country:US
Mailing Address - Phone:708-239-8513
Mailing Address - Fax:224-534-7327
Practice Address - Street 1:4959 GOLF RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1537
Practice Address - Country:US
Practice Address - Phone:847-433-3737
Practice Address - Fax:224-534-7327
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036086345207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL707680Medicare ID - Type UnspecifiedPROVIDER #