Provider Demographics
NPI:1528023207
Name:LEVIN, SANFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12485 SW 137TH AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4216
Mailing Address - Country:US
Mailing Address - Phone:305-385-8344
Mailing Address - Fax:305-382-7986
Practice Address - Street 1:12485 SW 137TH AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4216
Practice Address - Country:US
Practice Address - Phone:305-385-8344
Practice Address - Fax:305-382-7986
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20176208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007148300Medicaid