MEDICARE: LEVINE FOOT & ANKLE SURGERY

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	213ES0103X	Foot & Ankle Surgery Podiatrist	A5360	CA

General Provider Information

NPI Number	:	1790262590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVINE FOOT & ANKLE SURGERY

Provider Business Mailing Address
First Line	:	10061 RIVERSIDE DR # 1049
Second Line	:
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 W ALAMEDA AVE STE 401A
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4409
Country	:	US
Telephone Number	:	818-450-6656
Fax Number	:	818-484-2941

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PATRICK LEVINE
Credential	:	DPM
Telephone Number	:	818-450-6656

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	06/04/2020

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