Basic Information
| Provider Information | |||||||||
| NPI: | 1578524526 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVIN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4453 CASTOR AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191243846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157442266 | ||||||||
| FaxNumber: | 2157439247 | ||||||||
| Practice Location | |||||||||
| Address1: | 4453 CASTOR AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191243846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157442266 | ||||||||
| FaxNumber: | 2157439247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | OS012196 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.