Provider Demographics
NPI:1649374026
Name:LEVY, MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:LEVY
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 1:201 NW 82ND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7808
Mailing Address - Country:US
Mailing Address - Phone:954-473-0553
Mailing Address - Fax:954-473-0893
Practice Address - Street 1:201 NW 82ND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7808
Practice Address - Country:US
Practice Address - Phone:954-473-0553
Practice Address - Fax:954-473-0893
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026721174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29729OtherEMPIRE BC/BS
FLP00020471OtherRAIL ROAD MEDICARE
FL0648004OtherCIGNA
FLP00020471OtherRAIL ROAD MEDICARE
FL29729OtherEMPIRE BC/BS
FLP00020471OtherRAIL ROAD MEDICARE