1568630952 NPI number — JEFFREY R LEVIN MD PC

Table of content: (NPI 1568630952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568630952 NPI number — JEFFREY R LEVIN MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY R LEVIN MD PC
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:
1568630952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3061 CHRISTY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48603-2267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-791-2455
Provider Business Mailing Address Fax Number:
989-791-1392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4705 TOWNE CTR
Provider Second Line Business Practice Location Address:
STE 302
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48604-2818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-249-8001
Provider Business Practice Location Address Fax Number:
989-249-8009
Provider Enumeration Date:
02/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEVIN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-249-8001

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  JL053156 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3076460 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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