Provider Demographics
NPI:1982816955
Name:LEVINE, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
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:P.O. BOX 652
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0652
Mailing Address - Country:US
Mailing Address - Phone:765-599-3121
Mailing Address - Fax:765-521-1468
Practice Address - Street 1:2200 FOREST RIDGE PKWY
Practice Address - Street 2:SUITE #310
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2943
Practice Address - Country:US
Practice Address - Phone:765-599-3121
Practice Address - Fax:765-521-1468
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036984A2083X0100X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400052326Medicare PIN