MEDICARE: MICHAEL S LEVY DO PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	725	NV

General Provider Information

NPI Number	:	1346785151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL S LEVY DO PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	4445 S JONES BLVD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3371
Country	:	US
Telephone Number	:	702-873-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4445 S JONES BLVD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3371
Country	:	US
Telephone Number	:	702-873-7800
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL S LEVY
Credential	:	DO
Telephone Number	:	702-873-7800

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	01/03/2017

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