Provider Demographics
NPI:1053325365
Name:LEVITT, JODIE KAREN (MD)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:KAREN
Last Name:LEVITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 E 2100 S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3760
Mailing Address - Country:US
Mailing Address - Phone:801-363-2473
Mailing Address - Fax:866-363-3441
Practice Address - Street 1:1327 EAST 2100 SOUTH
Practice Address - Street 2:SUITE 101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105
Practice Address - Country:US
Practice Address - Phone:801-363-2473
Practice Address - Fax:866-363-3441
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5166746-1205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG34747Medicare UPIN
UT00000487Medicare ID - Type UnspecifiedMEDICARE