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1881694990

NPI Code Detail

MEDICARE: DR. JOHN ORELL LEVINE MD

MEDICARE: DR. JOHN ORELL LEVINE MD

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	207Q00000X	Family Medicine Physician	01047772	IN
2	207P00000X	Emergency Medicine Physician	036157490	IL
3	207P00000X	Emergency Medicine Physician	01047772A	IN
4	207Q00000X	Family Medicine Physician	036157490	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	080128017	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000082847	OTHER		BCBS
2	10339	OTHER		PHP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881694990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ORELL LEVINE MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:	SUITE 130 PROVIDER ENROLLMENT
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:	765-747-4236
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 W UNIVERSITY AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47303-3428
Country	:	US
Telephone Number	:	765-747-4236
Fax Number	:	765-741-2961

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	08/05/2021

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Directions to “ DR. JOHN ORELL LEVINE MD” Practice Location

Language	Start Address	Practice Location

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