Healthcare Provider Details

I. General information

NPI: 1447348370
Provider Name (Legal Business Name): MICHAEL DAVID LEVINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 VERDUGO BLVD
GLENDALE CA
91208-1407
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-6696
  • Fax:
Mailing address:
  • Phone: 323-409-6696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA97381
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberA97381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: