Provider Demographics
NPI:1548236490
Name:LEVY, JOEL M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:M
Last Name:LEVY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 W. DR MARTIN L. KING BLVD.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-879-7850
Mailing Address - Fax:813-870-3569
Practice Address - Street 1:2511 W. DR. MARTIN L. KING BLVD. JR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-879-7850
Practice Address - Fax:813-870-3569
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO774213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041004700Medicaid
FL162337800OtherDEPT. OF LABOR
FL10174701OtherCITRUS HEALTHCARE
FLCG1740OtherRAILROAD MEDICARE
FL204232OtherAVMED HEALTH
FL03821OtherWELLCARE
FL1386OtherOPTIMUM HEALTH
FL202709OtherAMERIGROUP
FL10174701OtherCITRUS HEALTHCARE
FL87335XMedicare Oscar/Certification
FLT84641Medicare UPIN