Provider Demographics
NPI:1578626784
Name:DANIEL LEVITAN MD INC
Entity Type:Organization
Organization Name:DANIEL LEVITAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-848-5595
Mailing Address - Street 1:255 E ORANGE GROVE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502
Mailing Address - Country:US
Mailing Address - Phone:818-848-5595
Mailing Address - Fax:818-848-5749
Practice Address - Street 1:435 ARDEN AVE
Practice Address - Street 2:STE 380
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91209
Practice Address - Country:US
Practice Address - Phone:818-848-5595
Practice Address - Fax:818-848-5749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0069980Medicaid
CAW10087BMedicare ID - Type Unspecified