Provider Demographics
NPI:1033739693
Name:LEVY, JOSEPH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12712 COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-5134
Mailing Address - Country:US
Mailing Address - Phone:501-352-8917
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST # ST4C
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-993-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program