Healthcare Provider Details

I. General information

NPI: 1003980442
Provider Name (Legal Business Name): MICHAEL SCOTT LEVINE M.D., AMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2006
Last Update Date: 09/11/2025
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 TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG46153
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG46153
License Number StateCA

VIII. Authorized Official

Name: MICHAEL SCOTT LEVINE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-794-1300