Provider Demographics
NPI:1811999030
Name:LEVY, MORTON A (MD)
Entity type:Individual
Prefix:DR
First Name:MORTON
Middle Name:A
Last Name:LEVY
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 1:4000 NORTH ILLINOIS
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1946
Mailing Address - Country:US
Mailing Address - Phone:618-236-1000
Mailing Address - Fax:618-236-1299
Practice Address - Street 1:4000 NORTH ILLINOIS
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1946
Practice Address - Country:US
Practice Address - Phone:618-236-1000
Practice Address - Fax:618-236-1299
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-055967207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL77876OtherPIN
IL028-0261043Medicaid
IL028-0261043Medicaid