MEDICARE: DR. JACOB DANIEL LEVY MD

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	207RC0000X	Cardiovascular Disease Physician	2264571	NY
2	207RC0000X	Cardiovascular Disease Physician	D84453	MD
3	207RC0000X	Cardiovascular Disease Physician	R6432	TX
4	207RC0000X	Cardiovascular Disease Physician	32799	OK
5	207RC0000X	Cardiovascular Disease Physician	04-41155	KS
6	207RC0000X	Cardiovascular Disease Physician	01079565A	IN
7	207RC0000X	Cardiovascular Disease Physician	68773	WI
8	207RC0000X	Cardiovascular Disease Physician	ME133455	FL
9	207RC0000X	Cardiovascular Disease Physician	0101263074	VA
10	207RC0000X	Cardiovascular Disease Physician	036145353	IL
11	207RC0000X	Cardiovascular Disease Physician	057393	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0-570-912-6	OTHER		ECFMG
2	057393	OTHER	GA	GA STATE LICENSE
3	2264571	OTHER	NY	NY STATE LICENSE

General Provider Information

NPI Number	:	1679594675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB DANIEL LEVY MD

Provider Business Mailing Address
First Line	:	2665 N DECATUR RD
Second Line	:	SUITE 260
City	:	DECATUR
State	:	GA
Zip	:	30033-6149
Country	:	US
Telephone Number	:	404-297-9077
Fax Number	:	404-296-1220

Provider Business Practice Location Address
First Line	:	1011 BOWLES AVE
Second Line	:	SUITE 300
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117
Country	:	US
Telephone Number	:	636-496-5048
Fax Number	:

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	03/13/2023

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