Provider Demographics
NPI:1497846687
Name:LEVINE, STEPHEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:S.
Other - Middle Name:M
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12343 ERWIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4613
Mailing Address - Country:US
Mailing Address - Phone:760-243-9316
Mailing Address - Fax:818-761-9847
Practice Address - Street 1:12343 ERWIN ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4613
Practice Address - Country:US
Practice Address - Phone:760-243-9316
Practice Address - Fax:818-761-9847
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G21183207T00000X, 2084P0005X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G211830Medicaid
CA00G211830Medicaid
CAWG21183AMedicare PIN