Basic Information
| Provider Information | |||||||||
| NPI: | 1295779775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVIN | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ERIE CT | ||||||||
| Address2: | SUITE 6160 | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603022566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087631490 | ||||||||
| FaxNumber: | 7087632394 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ERIE CT | ||||||||
| Address2: | SUITE 6160 | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603022566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087631490 | ||||||||
| FaxNumber: | 7087632394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 07/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 336-052871 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.