Provider Demographics
NPI:1104815232
Name:LEVINE, ROBERT C (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:390 ENTERPRISE CT STE 103
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0320
Mailing Address - Country:US
Mailing Address - Phone:248-480-4222
Mailing Address - Fax:248-336-9137
Practice Address - Street 1:911 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1934
Practice Address - Country:US
Practice Address - Phone:248-336-4000
Practice Address - Fax:248-336-9137
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051449207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI70-0-F32947-0OtherBCBS CPIN #
MI1104815232Medicaid
P46550035Medicare PIN
E49436Medicare UPIN