Healthcare Provider Details

I. General information

NPI: 1770928418
Provider Name (Legal Business Name): ROBERT S LEVY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 MONROE ST
DEARBORN MI
48124-3491
US

IV. Provider business mailing address

2845 MONROE ST
DEARBORN MI
48124-3491
US

V. Phone/Fax

Practice location:
  • Phone: 313-730-0070
  • Fax:
Mailing address:
  • Phone: 313-730-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301043776
License Number StateMI

VIII. Authorized Official

Name: DR. ROBERT LEVY
Title or Position: OWNER
Credential: M.D.
Phone: 313-730-0070