Provider Demographics
NPI:1760673776
Name:H I LEVIN D.O.
Entity Type:Organization
Organization Name:H I LEVIN D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-788-1881
Mailing Address - Street 1:4530 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4523
Mailing Address - Country:US
Mailing Address - Phone:386-788-1881
Mailing Address - Fax:386-788-8556
Practice Address - Street 1:4530 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4523
Practice Address - Country:US
Practice Address - Phone:386-788-1881
Practice Address - Fax:386-788-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0002929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1437Medicare PIN