=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548279904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREW LEVINE MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 09/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 E SAVANNAH AVE STE 4
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78503-1728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-383-4041
-----------------------------------------------------
Fax | 956-383-4183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 E SAVANNAH AVE STE 4
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78503-1728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-383-4041
-----------------------------------------------------
Fax | 956-383-4183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANDREW LEVINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 956-383-4041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | K4124
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------