Basic Information
| Provider Information | |||||||||
| NPI: | 1427139591 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVIN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | HARLAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2311 LOVERIDGE RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254312600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2311 LOVERIDGE RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254312600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 09/11/2012 | ||||||||
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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 | 2084P0800X | G016918 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | G016918 | 01 | CA | CALIF STATE LICENSE NUMBE | OTHER |