Provider Demographics
NPI:1891893434
Name:LEVINE, NOAH LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:LEE
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7125 GRAND MONTECITO PKWY
Mailing Address - Street 2:ST 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149
Mailing Address - Country:US
Mailing Address - Phone:702-839-2010
Mailing Address - Fax:702-839-2977
Practice Address - Street 1:7125 GRAND MONTECITO PKWY
Practice Address - Street 2:ST 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149
Practice Address - Country:US
Practice Address - Phone:702-839-2010
Practice Address - Fax:702-839-2977
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0110213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002102012Medicaid
NV480033467OtherRAILROAD MEDICARE
NVBJ752Medicare PIN
NV002102012Medicaid