Provider Demographics
NPI:1588924559
Name:LEVY, LAWRENCE BERNARD
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:BERNARD
Last Name:LEVY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 NORTH MICHIGAN AVE
Mailing Address - Street 2:SUITE #701
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-3952
Mailing Address - Country:US
Mailing Address - Phone:312-726-7595
Mailing Address - Fax:312-726-1054
Practice Address - Street 1:333 N MICHIGAN AVE
Practice Address - Street 2:SUITE #701
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3901
Practice Address - Country:US
Practice Address - Phone:312-726-7595
Practice Address - Fax:312-726-1054
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-045764207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine