1114057585 NPI number — STEPHEN F LEVIN DPM PA

Table of content: ELANA SCHULMAN (NPI 1164043980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114057585 NPI number — STEPHEN F LEVIN DPM PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN F LEVIN DPM PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114057585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26827 FOGGY CREEK RD
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
WESLEY CHAPEL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33544-6768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-973-3535
Provider Business Mailing Address Fax Number:
813-907-2963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26827 FOGGY CREEK RD
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
WESLEY CHAPEL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33544-6768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-973-3535
Provider Business Practice Location Address Fax Number:
813-907-2963
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEVIN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
FARBER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
813-973-3535

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO2726 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009078400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB5693 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 003CS . This is a "BLUE CROSS BLUE SHIELD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 390427001 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390427000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009078400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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