Individual
RONALD P LEVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1 SAINT ANTHONYS WAY, ALTON, IL 62002-4568
(618) 465-4520
Mailing address
36 GARDEN CTR, BROOMFIELD, CO 80020-1730
(303) 465-0401
(303) 404-2317
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036110681
IL
2085R0202X
Diagnostic Radiology Physician
34427
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110681-1
—
IL
01
—
036110681-2
MEDICAID
IL
01
—
IL4399001
MEDICARE
IL
01
—
P00142206
RAILROAD MEDICARE
IL
Enumeration date
03/30/2006
Last updated
02/07/2011
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