Healthcare Provider Details

I. General information

NPI: 1437549243
Provider Name (Legal Business Name): ELI S. LEVINE, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2015
Last Update Date: 05/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NW 13TH ST SUITE 4B
BOCA RATON FL
33486-2359
US

IV. Provider business mailing address

951 NW 13TH ST SUITE 4B
BOCA RATON FL
33486-2359
US

V. Phone/Fax

Practice location:
  • Phone: 561-235-5621
  • Fax: 561-235-5495
Mailing address:
  • Phone: 561-235-5621
  • Fax: 561-235-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME121908
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME121908
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME121908
License Number StateFL

VIII. Authorized Official

Name: DR. ELI S LEVINE
Title or Position: PRESIDENT
Credential: MD
Phone: 561-235-5621