Provider Demographics
NPI:1578907846
Name:LEVIN, ELIZABETH EDLAVITCH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EDLAVITCH
Last Name:LEVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SUSAN
Other - Last Name:EDLAVITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3435 W BROADWAY AVE STE 1135
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2974
Mailing Address - Country:US
Mailing Address - Phone:763-581-2800
Mailing Address - Fax:763-581-2801
Practice Address - Street 1:3435 W BROADWAY AVE STE 1135
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2974
Practice Address - Country:US
Practice Address - Phone:763-581-2800
Practice Address - Fax:763-581-2801
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN65172207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology