Provider Demographics
NPI:1760555742
Name:LEVINE, IRA KEITH (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:KEITH
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1090 KANE CONCOURSE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2130
Mailing Address - Country:US
Mailing Address - Phone:305-865-0272
Mailing Address - Fax:305-865-5612
Practice Address - Street 1:1090 KANE CONCOURSE
Practice Address - Street 2:SUITE 205
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2130
Practice Address - Country:US
Practice Address - Phone:305-865-0272
Practice Address - Fax:305-865-5612
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49912207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D50964Medicare UPIN
04234Medicare ID - Type Unspecified