Provider Demographics
NPI:1417977661
Name:LEVIN, PHILLIP M (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:M
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 615E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-652-8132
Mailing Address - Fax:310-659-3815
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 615E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-652-8132
Practice Address - Fax:310-659-3815
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA0212192086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A22518Medicare UPIN
CAWA21219KMedicare PIN
CAWA21219DMedicare PIN
CAA21219Medicare PIN