MEDICARE: DR. MICHAEL IRA LEVINE 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	207R00000X	Internal Medicine Physician	169142	NY
2	174400000X	Specialist	38379	WI
3	207RN0300X	Nephrology Physician	38379-020	WI
4	207RN0300X	Nephrology Physician	169142	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912971250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL IRA LEVINE M.D.

Provider Business Mailing Address
First Line	:	1434 WILLIAMSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2507
Country	:	US
Telephone Number	:	646-759-5453
Fax Number	:	646-374-4940

Provider Business Practice Location Address
First Line	:	1434 WILLIAMSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2507
Country	:	US
Telephone Number	:	646-759-5453
Fax Number	:	646-374-4940

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	10/28/2019

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