Provider Demographics
NPI:1316015589
Name:LEVY, HORACE GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:HORACE
Middle Name:GEORGE
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 1:2246 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4254
Mailing Address - Country:US
Mailing Address - Phone:734-243-0220
Mailing Address - Fax:734-243-4269
Practice Address - Street 1:2246 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4254
Practice Address - Country:US
Practice Address - Phone:734-243-0220
Practice Address - Fax:734-243-4269
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036836207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4748771Medicaid
MI4748771Medicaid
MI0N87960Medicare PIN