Provider Demographics
NPI:1740257716
Name:LEVIN, MICHAEL L (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
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 1:333 UNIVERSITY AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6535
Mailing Address - Country:US
Mailing Address - Phone:916-333-5800
Mailing Address - Fax:916-333-5937
Practice Address - Street 1:333 UNIVERSITY AVE STE 140
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6535
Practice Address - Country:US
Practice Address - Phone:916-333-5800
Practice Address - Fax:916-333-5937
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41785208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26155ZMedicaid
CAZZZ26155ZMedicare ID - Type UnspecifiedMEDICARE