Provider Demographics
NPI:1255662573
Name:LEVY, DONALD MORRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MORRIS
Last Name:LEVY
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 1:4348 W TARRYTOWN LN
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-4850
Mailing Address - Country:US
Mailing Address - Phone:858-759-6939
Mailing Address - Fax:
Practice Address - Street 1:4348 W TARRYTOWN LN
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-4850
Practice Address - Country:US
Practice Address - Phone:858-759-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14694-20282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB54562Medicare UPIN