Healthcare Provider Details

I. General information

NPI: 1538666151
Provider Name (Legal Business Name): ARIANA MIREILLE LEVIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 01/09/2023
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE 6TH FL
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8096
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3937
  • Fax: 314-362-3725
Mailing address:
  • Phone: 314-362-3937
  • Fax: 314-362-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number2022026792
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: