Individual
DR. MICHAEL IRA LEVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1434 WILLIAMSBRIDGE RD, BRONX, NY 10461-2507
(646) 759-5453
(646) 374-4940
Mailing address
1434 WILLIAMSBRIDGE RD, BRONX, NY 10461-2507
(646) 759-5453
(646) 374-4940
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
38379
WI
207R00000X
Internal Medicine Physician
169142
NY
207RN0300X
Nephrology Physician
Primary
169142
NY
207RN0300X
Nephrology Physician
38379-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01110109
—
NY
05
—
32303500
—
WI
Enumeration date
02/14/2006
Last updated
10/28/2019
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