Provider Demographics
NPI:1063497980
Name:LEVITAN, LYNNE A (MD)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:A
Last Name:LEVITAN
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 1:2539 W CALLE PARAISO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745
Mailing Address - Country:US
Mailing Address - Phone:916-798-0127
Mailing Address - Fax:
Practice Address - Street 1:2539 W CALLE PARAISO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2514
Practice Address - Country:US
Practice Address - Phone:916-798-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA792130207L00000X
AZ41353207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI13187Medicare UPIN
CA00A792130Medicare ID - Type Unspecified