Basic Information
| Provider Information | |||||||||
| NPI: | 1205120110 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MICHAEL L. LEVINE MD PA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3280 OLD BOYNTON RD | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334366506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617333010 | ||||||||
| FaxNumber: | 5617330039 | ||||||||
| Practice Location | |||||||||
| Address1: | 3280 OLD BOYNTON RD | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334366506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617333010 | ||||||||
| FaxNumber: | 5617330039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2011 | ||||||||
| LastUpdateDate: | 12/20/2013 | ||||||||
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| AuthorizedOfficialLastName: | FAMULARO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5615032555 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME77689 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.