Basic Information
| Provider Information | |||||||||
| NPI: | 1740610252 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVY | ||||||||
| FirstName: | ALAN | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | CNIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1604 VISA DR. | ||||||||
| Address2: | STE. 1 | ||||||||
| City: | NORMAL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3094541100 | ||||||||
| FaxNumber: | 3094547348 | ||||||||
| Practice Location | |||||||||
| Address1: | 1604 VISA DR. | ||||||||
| Address2: | STE. 1 | ||||||||
| City: | NORMAL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3094541100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2013 | ||||||||
| LastUpdateDate: | 05/08/2019 | ||||||||
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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 | 246ZE0600X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.