Provider Demographics
NPI:1124050406
Name:LEVENTHAL, JOSEPH R (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:LEVENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:676 N SAINT CLAIR ST FL 19
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-695-8900
Mailing Address - Fax:312-695-9194
Practice Address - Street 1:676 N SAINT CLAIR ST FL 19
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-695-8900
Practice Address - Fax:312-695-9194
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036092684204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092684Medicaid
IL357890Medicare PIN