Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 036092684 | IL |
NPI | 1124050406 |
---|---|
Provider Name | Joseph R Leventhal |
First Address | Chicago, IL 60611-2927 |
Second Address | Chicago, IL 60611-2927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 12/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036092684 | (05) | IL |
F42663 | (02) |