Provider Demographics
NPI:1881898872
Name:LEVINE, MICHAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:105KLACK RD
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-0385
Mailing Address - Country:US
Mailing Address - Phone:970-453-0602
Mailing Address - Fax:970-453-9331
Practice Address - Street 1:105 KLACK RD.
Practice Address - Street 2:105KLACK RD.
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-0385
Practice Address - Country:US
Practice Address - Phone:970-453-0602
Practice Address - Fax:970-453-9331
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CO20623207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC18366Medicare UPIN