Provider Demographics
NPI:1699835256
Name:LEVY, STUART A (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:A
Last Name:LEVY
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 1:9509 NORTH WAKEFIELD COURT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-1245
Mailing Address - Country:US
Mailing Address - Phone:414-351-1530
Mailing Address - Fax:414-351-1599
Practice Address - Street 1:9509 N WAKEFIELD CT
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-1245
Practice Address - Country:US
Practice Address - Phone:414-351-1530
Practice Address - Fax:414-351-1599
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17518207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30846200Medicaid
WI01696Medicare ID - Type Unspecified
WIB54565Medicare UPIN