Provider Demographics
NPI:1679653828
Name:LEVY, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 E ROYALTON RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3532
Mailing Address - Country:US
Mailing Address - Phone:440-526-8222
Mailing Address - Fax:440-526-7881
Practice Address - Street 1:6909 ROYALTON RD STE 304
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-2478
Practice Address - Country:US
Practice Address - Phone:440-526-8222
Practice Address - Fax:440-526-7881
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350680776L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics