Provider Demographics
NPI:1942241575
Name:LEVINE, MARC IVEN (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:IVEN
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 SW CENTER CT
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2312
Mailing Address - Country:US
Mailing Address - Phone:177-222-2115
Mailing Address - Fax:
Practice Address - Street 1:111 SE OSCEOLA ST STE 100
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2114
Practice Address - Country:US
Practice Address - Phone:772-223-2115
Practice Address - Fax:772-223-9238
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56758207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
17953OtherBCBS
FL17953OMedicare PIN
FLF38548Medicare UPIN
FL17953MMedicare PIN