Provider Demographics
NPI:1730122664
Name:LEVIN, FREDRIC D (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:D
Last Name:LEVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3759
Mailing Address - Country:US
Mailing Address - Phone:231-777-2568
Mailing Address - Fax:231-773-4310
Practice Address - Street 1:1314 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3759
Practice Address - Country:US
Practice Address - Phone:231-777-2568
Practice Address - Fax:231-773-4310
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007790204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1343671Medicaid
MI1343671Medicaid
MI0M19870002Medicare ID - Type Unspecified5101007790