Basic Information
| Provider Information | |||||||||
| NPI: | 1407836786 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVIN | ||||||||
| FirstName: | SHELDON | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 W FOREST AVE | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860011479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287732505 | ||||||||
| FaxNumber: | 9287732504 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 W FOREST AVE | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860011479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287732505 | ||||||||
| FaxNumber: | 9287732504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 03/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35-05-1476L | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 889203 | 05 | OH | MEDICAID |