Provider Demographics
NPI:1336128859
Name:LEVINE, TODD D (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:D
Last Name:LEVINE
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 1:5090 N. 40TH ST
Mailing Address - Street 2:STE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2134
Mailing Address - Country:US
Mailing Address - Phone:602-258-3354
Mailing Address - Fax:
Practice Address - Street 1:5090 N. 40TH ST
Practice Address - Street 2:STE 250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2134
Practice Address - Country:US
Practice Address - Phone:602-258-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ269772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ454132Medicaid
AZZ25048Medicare PIN
AZ454132Medicaid