Basic Information
| Provider Information | |||||||||
| NPI: | 1427152081 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVINE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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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: | 09/12/2006 | ||||||||
| LastUpdateDate: | 12/31/2014 | ||||||||
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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 | 174400000X | ME77689 | FL | N | Other Service Providers | Specialist | 207W00000X | ME77689 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.