Basic Information
| Provider Information | |||||||||
| NPI: | 1679654156 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVIN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MEAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE ST SE | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123028200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1020 W BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554112504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123028200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207Q00000X | 40305 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | HP27115 | 01 | MN | HEALTH PARTNERS | OTHER | 812574 | 01 | MN | ARAZ | OTHER | 01-09760 | 01 | MN | MEDICA-CHOICE | OTHER | 01-09760 | 01 | MN | MEDICA-PRIMARY | OTHER | 557326200 | 05 | MN | MEDICAID | 36Q96LE | 01 | MN | BCBS | OTHER | 122086 | 01 | MN | UCARE | OTHER | 1017630 | 01 | MN | PREFERREDONE | OTHER | 572859 | 01 | MN | FAIRVIEW | OTHER |