Provider Demographics
NPI:1003015744
Name:BRETT A. LEVINE, M.D., PC.
Entity Type:Organization
Organization Name:BRETT A. LEVINE, M.D., PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-543-2313
Mailing Address - Street 1:409 N PACIFIC COAST HWY STE 482
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2870
Mailing Address - Country:US
Mailing Address - Phone:310-543-2313
Mailing Address - Fax:310-944-9295
Practice Address - Street 1:21320 HAWTHORNE BLVD STE 119
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5651
Practice Address - Country:US
Practice Address - Phone:310-543-2313
Practice Address - Fax:310-944-9295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74806207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W19127Medicare PIN
F74957Medicare UPIN