Provider Demographics
NPI:1588760557
Name:LEVINE, BARRY MARK (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:MARK
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:201 E HURON ST
Mailing Address - Street 2:12-150
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3197
Mailing Address - Country:US
Mailing Address - Phone:312-926-3600
Mailing Address - Fax:312-926-3606
Practice Address - Street 1:201 E HURON ST
Practice Address - Street 2:12-150
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3197
Practice Address - Country:US
Practice Address - Phone:312-926-3600
Practice Address - Fax:312-926-3606
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-02-09
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Provider Licenses
StateLicense IDTaxonomies
IL036060341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL479030OtherMEDICARE ID
IL479030OtherMEDICARE ID