Provider Demographics
NPI:1912965401
Name:LEVITAN, VICTOR D (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:D
Last Name:LEVITAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:806 CENTRAL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5613
Mailing Address - Country:US
Mailing Address - Phone:847-654-9667
Mailing Address - Fax:847-787-1315
Practice Address - Street 1:806 CENTRAL AVE STE 103
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5613
Practice Address - Country:US
Practice Address - Phone:847-654-9667
Practice Address - Fax:847-787-9667
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-100810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH09828Medicare UPIN