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General NPI Number Information
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NPI Number | 1326509910
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Entity Type | Individual
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Provider Name | MICHELLE DANIELLE LEVINE DO
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Gender | Female
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 1420 W MIDWAY BLVD
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City | BROOMFIELD
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State | CO
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Zip | 80020-2090
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Country | US
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Telephone | 303-466-1866
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 W MIDWAY BLVD
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City | BROOMFIELD
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State | CO
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Zip | 80020-2090
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Country | US
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Telephone | 303-466-1866
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0065224
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License Number State | CO
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