Provider Demographics
NPI:1053905364
Name:LEVINE, ALIX
Entity type:Individual
Prefix:MRS
First Name:ALIX
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 E KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-6352
Mailing Address - Country:US
Mailing Address - Phone:847-702-3887
Mailing Address - Fax:
Practice Address - Street 1:746 E KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-6352
Practice Address - Country:US
Practice Address - Phone:847-702-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist