Provider Demographics
NPI:1306901004
Name:LEBOVITZ, PHIL S (MD)
Entity type:Individual
Prefix:DR
First Name:PHIL
Middle Name:S
Last Name:LEBOVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:122 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 1311
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6191
Mailing Address - Country:US
Mailing Address - Phone:312-692-1500
Mailing Address - Fax:312-692-6808
Practice Address - Street 1:122 S MICHIGAN AVE
Practice Address - Street 2:SUITE 1311
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6191
Practice Address - Country:US
Practice Address - Phone:312-692-1500
Practice Address - Fax:312-692-6808
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL360438462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19816Medicare PIN