Provider Demographics
NPI:1457639189
Name:LEVINE, MIRIAM TOVA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:TOVA
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:19251 MACK AVE STE 333
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2898
Mailing Address - Country:US
Mailing Address - Phone:313-343-7280
Mailing Address - Fax:313-343-7921
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:UNIVERSITY HEALTH CENTER SUITE 2E MEDICAL EDUCATION
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2018-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301099181207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine