Provider Demographics
NPI:1093743106
Name:LEVIN, RONALD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BRUCE
Last Name:LEVIN
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 1:16151 19 MILE ROAD, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-228-1760
Mailing Address - Fax:586-228-2672
Practice Address - Street 1:16151 19 MILE ROAD, SUITE 300
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-228-1760
Practice Address - Fax:586-228-2672
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI060205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3493490Medicaid
MI0E06281016Medicare ID - Type Unspecified
MI3493490Medicaid