Provider Demographics
NPI:1114228921
Name:IRA K LEVINE M.D. P.A.
Entity Type:Organization
Organization Name:IRA K LEVINE M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-865-0272
Mailing Address - Street 1:1090 KANE CONCOURSE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2130
Mailing Address - Country:US
Mailing Address - Phone:305-865-0272
Mailing Address - Fax:305-865-5612
Practice Address - Street 1:1090 KANE CONCOURSE
Practice Address - Street 2:SUITE 205
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2130
Practice Address - Country:US
Practice Address - Phone:305-865-0272
Practice Address - Fax:305-865-5612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IRA K LEVINE M.D. P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-10
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL49912207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04234Medicare PIN
FLD50964Medicare UPIN