Provider Demographics
NPI:1346358967
Name:LEVINSON, MARTIN P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:P
Last Name:LEVINSON
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 1:30400 TELEGRAPH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4538
Mailing Address - Country:US
Mailing Address - Phone:248-642-5437
Mailing Address - Fax:248-642-5456
Practice Address - Street 1:30400 TELEGRAPH RD STE 101
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4538
Practice Address - Country:US
Practice Address - Phone:248-642-5437
Practice Address - Fax:248-642-5456
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042276208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4254691Medicaid
F22195Medicare UPIN