Provider Demographics
NPI:1205120110
Name:MICHAEL L. LEVINE MD PA
Entity type:Organization
Organization Name:MICHAEL L. LEVINE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAMULARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-503-2555
Mailing Address - Street 1:3280 OLD BOYNTON RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6506
Mailing Address - Country:US
Mailing Address - Phone:561-733-3010
Mailing Address - Fax:561-733-0039
Practice Address - Street 1:3280 OLD BOYNTON RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6506
Practice Address - Country:US
Practice Address - Phone:561-733-3010
Practice Address - Fax:561-733-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77689174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG62065Medicare UPIN
FL46478Medicare PIN