Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301079601 | MI |
N | 207PE0004X | Emergency Medical Services | 4301079601 | MI |
NPI | 1063473478 |
---|---|
Provider Name | Dr. Phillip D Levy |
First Address | Northville, MI 48167-9085 |
Second Address | Detroit, MI 48201-2153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 17/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104418810 | (05) | MI |
104418829 | (05) | MI |
104538747 | (05) | MI |
104538774 | (05) | MI |
H33332 | (02) | MI |
PL079601 | BC/BS OF MI (01) | MI |