MEDICARE: DR. ELLIS ROBERT LEVIN M.D.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	G39127	CA

General Provider Information

NPI Number	:	1467569988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIS ROBERT LEVIN M.D.

Provider Business Mailing Address
First Line	:	612 29TH ST
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 E 7TH ST
Second Line	:	VA MEDICAL CENTER
City	:	LONG BEACH
State	:	CA
Zip	:	90822-5021
Country	:	US
Telephone Number	:	562-826-5748
Fax Number	:	562-826-5515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/08/2007

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