Provider Demographics
NPI:1881690675
Name:LEVINE, STUART BARRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:BARRY
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 NW23CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-241-0850
Mailing Address - Fax:561-989-0850
Practice Address - Street 1:5210 LINTON BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6542
Practice Address - Country:US
Practice Address - Phone:561-499-6850
Practice Address - Fax:561-637-0279
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1253213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85775Medicare UPIN
FL87677Medicare ID - Type Unspecified