Provider Demographics
NPI:1366481939
Name:LEVINE, LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 GLADES RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6465
Mailing Address - Country:US
Mailing Address - Phone:561-361-3133
Mailing Address - Fax:561-361-9695
Practice Address - Street 1:660 GLADES RD
Practice Address - Street 2:SUITE 310
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6465
Practice Address - Country:US
Practice Address - Phone:561-361-3133
Practice Address - Fax:561-361-9695
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 64720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27972OtherBLUE CROSS BLUE SHIELD FLA
FLWDQ97OtherEMPIRE BLUE CROSS BLUE SHIELD
FL0005525148OtherAETNA
FLK7086Medicare PIN
FLD20006Medicare UPIN
FL27972TMedicare PIN