Provider Demographics
NPI:1306805452
Name:LEVIN, NEIL B (DPM)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:B
Last Name:LEVIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:1675 BETHANY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178
Mailing Address - Country:US
Mailing Address - Phone:815-899-2575
Mailing Address - Fax:815-899-2581
Practice Address - Street 1:1675 BETHANY RD
Practice Address - Street 2:SUITE B
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178
Practice Address - Country:US
Practice Address - Phone:815-899-2575
Practice Address - Fax:815-899-2581
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2012-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL016003556213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T34414Medicare UPIN
K19976Medicare ID - Type Unspecified