Provider Demographics
NPI:1649219742
Name:LEVITT, MICHAEL J (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:LEVITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:3024 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3132
Practice Address - Country:US
Practice Address - Phone:615-851-6033
Practice Address - Fax:615-851-2018
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD144582085R0202X
TN144582085N0700X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1681750OtherCIGNA
TN300107905OtherRAILROAD MEDICARE
TNP00960022OtherRR MEDICARE - MTI
TN1509287Medicaid
TN3103415OtherBCBS
TN1509287OtherMEDICAID - MTI
TN3135901OtherBCBS
KY64796857OtherKY MEDICAID
TN1640137OtherUNITED HEALTHCARE OF TN
TN4076941OtherBCBS
TN4200841OtherBCBS TN
TN3193952Medicaid
TN4291330OtherBCBS - MTI
TNP00960022OtherRR MEDICARE - MTI
TN3193950Medicare PIN
TN1509287Medicaid
TN3193952Medicaid
TN4200841OtherBCBS TN
TN3193951Medicare PIN