Healthcare Provider Details

I. General information

NPI: 1699754358
Provider Name (Legal Business Name): TOWER NEPHROLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date: 03/26/2021
Reactivation Date: 05/18/2021

III. Provider practice location address

8641 WILSHIRE BLVD STE 300
BEVERLY HILLS CA
90211-2921
US

IV. Provider business mailing address

8641 WILSHIRE BLVD STE 300
BEVERLY HILLS CA
90211-2921
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-9162
  • Fax:
Mailing address:
  • Phone: 310-652-9162
  • Fax: 310-854-7259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberW11231
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL M LEVINE
Title or Position: PARTNER
Credential: M.D.,
Phone: 310-652-9162