Provider Demographics
NPI:1871572784
Name:LEVITAN, DENISE A (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:LEVITAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:900 W NELSON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6704
Practice Address - Country:US
Practice Address - Phone:773-296-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-105065207RX0202X
NC200400904207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000914Medicaid
SCQ0090PMedicaid
NC137H1OtherBCBS
NC804596OtherPARTNERS
NCD6161OtherMEDCOST
7166678OtherAETNA
VA10104645Medicaid
NC89137H1Medicaid
7166678OtherAETNA
VA10104645Medicaid
P00228008Medicare PIN