MEDICARE: DR. ERIC J LEVINE 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	2083X0100X	Occupational Medicine Physician	01043311A	IN

General Provider Information

NPI Number	:	1730161209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC J LEVINE MD

Provider Business Mailing Address
First Line	:	PO BOX 664050
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46266-4050
Country	:	US
Telephone Number	:	317-783-8009
Fax Number	:	317-783-8012

Provider Business Practice Location Address
First Line	:	4770 S EMERSON AVE
Second Line	:	STE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-6913
Country	:	US
Telephone Number	:	317-783-8009
Fax Number	:	317-783-8012

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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