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General NPI Number Information
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NPI Number | 1245468271
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Entity Type | Organization
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Legal Business Name | KENNETH M LEVINE, D.O. LTD
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 2121 S MILL AVE 114
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City | TEMPE
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State | AZ
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Zip | 85282-2138
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Country | US
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Telephone | 480-838-9388
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Fax | 480-840-1393
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Provider Business Mailing Address
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Address Line | 2121 S MILL AVE 114
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City | TEMPE
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State | AZ
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Zip | 85282-2138
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Country | US
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Telephone | 480-838-9388
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Fax | 480-840-1393
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Authorized Official
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Title or Position | MANAGER
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Name | KATIE GAYNE
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Credential |
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Telephone | 480-838-9388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 1696
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License Number State | AZ
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