Healthcare Provider Details

I. General information

NPI: 1962677864
Provider Name (Legal Business Name): MICHAEL NICHOLAS LEVAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE PEDIATRIC EMERGENCY MEDICINE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE PEDIATRIC EMERGENCY MEDICINE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2686
  • Fax: 414-266-2635
Mailing address:
  • Phone: 414-266-2686
  • Fax: 414-266-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2006036873
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number55790
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: