Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 4301048303 | MI |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 4301048303 | MI |
NPI | 1124049358 |
---|---|
Provider Name | Dr. Peter E. Levanovich |
First Address | Petoskey, MI 49770-2275 |
Second Address | Petoskey, MI 49770-2275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 21/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0602429802 | BLUE SHIELD INDIVIDUAL PI (01) | MI |
4087216 | (05) | MI |
A74816 | (02) | MI |
OM75740005 | (02) | MI |
P57812 | BLUE CARE NETWORK (01) | MI |