Provider Demographics
NPI:1720050016
Name:LEVINSON, DENNIS JOEL (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JOEL
Last Name:LEVINSON
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:PO BOX 2013
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-6013
Mailing Address - Country:US
Mailing Address - Phone:312-674-4010
Mailing Address - Fax:312-674-4001
Practice Address - Street 1:611 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4911
Practice Address - Country:US
Practice Address - Phone:312-674-4010
Practice Address - Fax:312-674-4001
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036042103207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036042103Medicaid
990013079OtherRR MEDICARE
IL21606301OtherBLUE CROSS/BLUS SHIELD
IL21606301OtherBLUE CROSS/BLUS SHIELD
IL036042103Medicaid