Provider Demographics
NPI:1043205867
Name:LEVINE, FREDERIC J (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:J
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 MAYFIELD RD
Mailing Address - Street 2:SUITE 418
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2271
Mailing Address - Country:US
Mailing Address - Phone:440-753-0018
Mailing Address - Fax:440-753-0035
Practice Address - Street 1:6803 MAYFIELD RD
Practice Address - Street 2:SUITE 418
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2271
Practice Address - Country:US
Practice Address - Phone:440-753-0018
Practice Address - Fax:440-753-0035
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060202208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0670944Medicare ID - Type UnspecifiedMEDICARE NUMBER
OHE72198Medicare UPIN