Provider Demographics
NPI:1730492414
Name:LEVIN, MARK MICHAELS (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MICHAELS
Last Name:LEVIN
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 1:689 SIERRA ROSE DR STE B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2076
Mailing Address - Country:US
Mailing Address - Phone:775-323-3000
Mailing Address - Fax:775-323-3001
Practice Address - Street 1:689 SIERRA ROSE DR STE B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2076
Practice Address - Country:US
Practice Address - Phone:775-323-3000
Practice Address - Fax:775-323-3001
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAE3307875208600000X
NV185662086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV18566OtherNEVADA STATE LICENSE