Basic Information
Provider Information
NPI: 1265512164
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEVIS
FirstName: WILLIAM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 745 FLETCHER DR
Address2:  
City: ELGIN
State: IL
PostalCode: 601234747
CountryCode: US
TelephoneNumber: 8478881300
FaxNumber: 8478881341
Practice Location
Address1: 745 FLETCHER DR
Address2:  
City: ELGIN
State: IL
PostalCode: 601234747
CountryCode: US
TelephoneNumber: 8478881300
FaxNumber: 8478881341
Other Information
ProviderEnumerationDate: 10/16/2006
LastUpdateDate: 02/19/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100X36111544ILY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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