Provider Demographics
NPI:1982676862
Name:LEVINE, MICHAEL G (MD, FACC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OLD PARK LN
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2507
Mailing Address - Country:US
Mailing Address - Phone:860-355-1149
Mailing Address - Fax:860-355-5957
Practice Address - Street 1:11 OLD PARK LN
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2507
Practice Address - Country:US
Practice Address - Phone:860-355-1149
Practice Address - Fax:860-355-5957
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT34504207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010034504CT04OtherANTHEM BC/BS
CTP984475OtherOXFORD
CT1033381OtherAETNA/USHC
CTOV8004OtherACS/HEALTHNET
CT714079-5104OtherCONNECTICARE
CT714079-5104OtherCONNECTICARE