Provider Demographics
NPI:1548257058
Name:SHEVITZ, DAVID M (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:SHEVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-7915
Mailing Address - Country:US
Mailing Address - Phone:630-725-2768
Mailing Address - Fax:630-725-2783
Practice Address - Street 1:5550 GLADES RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7205
Practice Address - Country:US
Practice Address - Phone:561-750-2130
Practice Address - Fax:561-367-6170
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME744612086S0129X
TN42176207K00000X
NC2007-00905207P00000X
NCME74461202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL758992100Medicaid
FL44702ZMedicare ID - Type Unspecified
FLP00889810Medicare PIN
FL758992100Medicaid
FLDE6533Medicare PIN
NC2021854Medicare PIN
FL44702YMedicare PIN
FL1689600846Medicare PIN
F14209Medicare UPIN