Provider Demographics
NPI:1346785151
Name:MICHAEL S LEVY DO PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL S LEVY DO PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-873-7800
Mailing Address - Street 1:4445 S JONES BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3371
Mailing Address - Country:US
Mailing Address - Phone:702-873-7800
Mailing Address - Fax:
Practice Address - Street 1:4445 S JONES BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3371
Practice Address - Country:US
Practice Address - Phone:702-873-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV725207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty