Healthcare Provider Details

I. General information

NPI: 1356415285
Provider Name (Legal Business Name): MICHAEL S LEVINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UCLA MEDICAL PLZ SUITE 723
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

100 UCLA MEDICAL PLZ SUITE 723
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-1300
  • Fax: 310-794-1304
Mailing address:
  • Phone: 310-794-1300
  • Fax: 310-794-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG46153
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG46153
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG46153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: