Basic Information
| Provider Information | |||||||||
| NPI: | 1831361617 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LEVY | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 SOUTH WOOD STREET, 130 CSN | ||||||||
| Address2: | UIC DEPARTMENT OF PATHOLOGY (MC847) | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3124139003 | ||||||||
| FaxNumber: | 3129967586 | ||||||||
| Practice Location | |||||||||
| Address1: | 840 SOUTH WOOD STREET, 130 CSN | ||||||||
| Address2: | UIC DEPARTMENT OF PATHOLOGY (MC847) | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3124139003 | ||||||||
| FaxNumber: | 3129967586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2008 | ||||||||
| LastUpdateDate: | 11/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZF0201X | 189220 | NY | N | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology | 207ZP0102X | 189220 | NY | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.