Healthcare Provider Details

I. General information

NPI: 1316015589
Provider Name (Legal Business Name): HORACE GEORGE LEVY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2246 N MONROE ST
MONROE MI
48162-4254
US

IV. Provider business mailing address

2246 N MONROE ST
MONROE MI
48162-4254
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-0220
  • Fax: 734-243-4269
Mailing address:
  • Phone: 734-243-0220
  • Fax: 734-243-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number4301036836
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: