Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 35060202 | OH |
NPI | 1043205867 |
---|---|
Provider Name | Dr. Frederic J. Levine |
First Address | Mayfield Hts, OH 44124-2271 |
Second Address | Mayfield Hts, OH 44124-2271 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E72198 | (02) | OH |