Provider Demographics
NPI:1831361617
Name:LEVY, BRUCE P (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:P
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:840 SOUTH WOOD STREET, 130 CSN
Mailing Address - Street 2:UIC DEPARTMENT OF PATHOLOGY (MC847)
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-413-9003
Mailing Address - Fax:312-996-7586
Practice Address - Street 1:840 SOUTH WOOD STREET, 130 CSN
Practice Address - Street 2:UIC DEPARTMENT OF PATHOLOGY (MC847)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-413-9003
Practice Address - Fax:312-996-7586
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY189220207ZF0201X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology