Provider Demographics
NPI:1558540476
Name:LEVIT, MICHAEL IRA (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:IRA
Last Name:LEVIT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1541 E SHARON DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4957
Mailing Address - Country:US
Mailing Address - Phone:602-300-8087
Mailing Address - Fax:602-298-2605
Practice Address - Street 1:1541 E SHARON DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4957
Practice Address - Country:US
Practice Address - Phone:602-300-8087
Practice Address - Fax:602-298-2605
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-27
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1488208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD47251Medicare UPIN