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General NPI Number Information
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NPI Number | 1124272638
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Entity Type | Organization
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Legal Business Name | MICHAEL I LEVI MEDICAL PLLC
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 1614 N JAMES ST
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City | ROME
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State | NY
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Zip | 13440-2830
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Country | US
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Telephone | 315-339-7411
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Fax |
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Provider Business Mailing Address
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Address Line | 610 CYPRESS ST
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City | ROME
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State | NY
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Zip | 13440-2154
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Country | US
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Telephone | 315-281-4485
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL IRA LEVI
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Credential | MD
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Telephone | 315-281-4485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 217243
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 217243
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License Number State | NY
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