MEDICARE: DR. BRENDAN H LEVY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	23692	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	H20176	OTHER	AZ	MEDICARE UPIN
5	Z76080	OTHER	AZ	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0742410	OTHER	AZ	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2Z0591	OTHER	AZ	HEALTHNET

General Provider Information

NPI Number	:	1548260474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDAN H LEVY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6190
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85246-6190
Country	:	US
Telephone Number	:	480-786-6655
Fax Number	:	480-786-6996

Provider Business Practice Location Address
First Line	:	600 S DOBSON RD
Second Line	:	BLDG. A
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5678
Country	:	US
Telephone Number	:	480-786-6655
Fax Number	:	480-786-6996

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	01/22/2008

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Directions to “ DR. BRENDAN H LEVY M.D.” Practice Location

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