Provider Demographics
NPI:1356829113
Name:LEVMED LLC
Entity Type:Organization
Organization Name:LEVMED LLC
Other - Org Name:LEVMED HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-314-6472
Mailing Address - Street 1:1519 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4201
Mailing Address - Country:US
Mailing Address - Phone:727-314-6472
Mailing Address - Fax:
Practice Address - Street 1:1519 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4201
Practice Address - Country:US
Practice Address - Phone:727-314-6472
Practice Address - Fax:727-619-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12495261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012768800Medicaid