Provider Demographics
NPI:1295744423
Name:LEVIN, OREN ISAAC (MD)
Entity type:Individual
Prefix:DR
First Name:OREN
Middle Name:ISAAC
Last Name:LEVIN
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 1:11827 ELMSCOURT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2768
Mailing Address - Country:US
Mailing Address - Phone:210-888-1450
Mailing Address - Fax:210-888-1452
Practice Address - Street 1:11827 ELMSCOURT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2768
Practice Address - Country:US
Practice Address - Phone:210-888-1450
Practice Address - Fax:210-888-1452
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361017902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232103OtherBCBS
IL201296Medicare ID - Type Unspecified
ILF42763Medicare UPIN