Provider Demographics
NPI:1760639884
Name:LEVY, PAUL MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:LEVY
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 1:7700 WASHINGTON VILLAGE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4094
Mailing Address - Country:US
Mailing Address - Phone:937-531-0195
Mailing Address - Fax:937-531-0196
Practice Address - Street 1:7700 WASHINGTON VILLAGE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-531-0195
Practice Address - Fax:937-531-0196
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-010479208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082370Medicaid
OH00000818480OtherANTHEM BC BS
OHH220060Medicare PIN
OH0082370Medicaid
OHH220061Medicare PIN