Provider Demographics
NPI:1700884129
Name:LEVY, NAOMI A (MD)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:A
Last Name:LEVY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 LAKE ST
Mailing Address - Street 2:SUITE 418
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1148
Mailing Address - Country:US
Mailing Address - Phone:708-386-4517
Mailing Address - Fax:708-386-4490
Practice Address - Street 1:1011 W LAKE ST
Practice Address - Street 2:SUITE 418
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1148
Practice Address - Country:US
Practice Address - Phone:708-386-4517
Practice Address - Fax:708-386-4490
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2009-11-06
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
IL036-0964782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206574Medicare ID - Type Unspecified