Provider Demographics
NPI:1306855598
Name:LEVERONE, THOMAS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:LEVERONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4148
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-4148
Mailing Address - Country:US
Mailing Address - Phone:310-792-3914
Mailing Address - Fax:310-792-3621
Practice Address - Street 1:3445 PACIFIC COAST HWY
Practice Address - Street 2:SUITE #110
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6658
Practice Address - Country:US
Practice Address - Phone:310-325-4555
Practice Address - Fax:310-325-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG55783207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93395Medicare UPIN
CAG55783BMedicare ID - Type Unspecified
CAG55783CMedicare ID - Type Unspecified