Provider Demographics
NPI:1710254511
Name:LEVINE, DENNIS LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LEE
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1142 E. 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030
Mailing Address - Country:US
Mailing Address - Phone:248-817-4742
Mailing Address - Fax:248-581-8719
Practice Address - Street 1:1142 E. 9 MILE RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030
Practice Address - Country:US
Practice Address - Phone:248-817-4742
Practice Address - Fax:248-581-8719
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC01909Medicare UPIN