Basic Information
Provider Information | |||||||||
NPI: | 1376973156 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LEVKOFF | ||||||||
FirstName: | ELINA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2950 CLEVELAND CLINIC BLVD | ||||||||
Address2: |   | ||||||||
City: | WESTON | ||||||||
State: | FL | ||||||||
PostalCode: | 333313609 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9546595000 | ||||||||
FaxNumber: | 9546596047 | ||||||||
Practice Location | |||||||||
Address1: | 4520 DONALD ROSS RD STE 200 | ||||||||
Address2: |   | ||||||||
City: | PALM BEACH GARDENS | ||||||||
State: | FL | ||||||||
PostalCode: | 334185105 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5619047200 | ||||||||
FaxNumber: | 5616244509 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/15/2013 | ||||||||
LastUpdateDate: | 05/08/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TRN19121 | FL | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | ME124639 | FL | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 017992800 | 05 | FL |   | MEDICAID |