Provider Demographics
NPI:1619952470
Name:LEVIN, MARC A (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:STE 405
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2919
Mailing Address - Country:US
Mailing Address - Phone:219-836-5167
Mailing Address - Fax:219-836-5249
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:STE 405
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2919
Practice Address - Country:US
Practice Address - Phone:219-836-5167
Practice Address - Fax:219-836-5249
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01023340A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000383681OtherANTHEM BCBS
IN100157720AMedicaid
INP00289364OtherMEDICARE RAILROAD
IN000000383681OtherANTHEM BCBS
INP00289364OtherMEDICARE RAILROAD