Provider Demographics
NPI:1740252048
Name:LEVINE, MICHAEL M (MD,)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:LEVINE
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Gender:M
Credentials:MD,
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Mailing Address - Street 1:8635 W 3RD ST
Mailing Address - Street 2:STE#485W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:310-652-9162
Mailing Address - Fax:310-854-7259
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:STE#485W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-652-9162
Practice Address - Fax:310-854-7259
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2017-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC39575207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88113Medicare UPIN
CAWC39575AMedicare PIN
CAW11231Medicare PIN