Healthcare Provider Details

I. General information

NPI: 1548236490
Provider Name (Legal Business Name): JOEL M LEVY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 W. DR. MARTIN L. KING BLVD. JR
TAMPA FL
33607
US

IV. Provider business mailing address

2511 W. DR MARTIN L. KING BLVD.
TAMPA FL
33607
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-7850
  • Fax: 813-870-3569
Mailing address:
  • Phone: 813-879-7850
  • Fax: 813-870-3569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: