Individual
DR. JOHN ORELL LEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 747-4236
(765) 741-2961
Mailing address
250 N SHADELAND AVE, SUITE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
(765) 747-4236
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01047772A
IN
207P00000X
Emergency Medicine Physician
Primary
036157490
IL
207Q00000X
Family Medicine Physician
01047772
IN
207Q00000X
Family Medicine Physician
036157490
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082847
BCBS
—
01
—
080128017
RR MEDICARE
—
01
—
10339
PHP
—
05
—
200153850
—
IN
05
—
200153850A
—
IN
Enumeration date
07/29/2005
Last updated
08/05/2021
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