Provider Demographics
NPI:1154368850
Name:LEVINE, DONALD PAUL (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:PAUL
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1420 STEPHENSON HWY
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5972
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:50 E CANFIELD
Practice Address - Street 2:GENERAL MEDICINE AMBULATORY PRACTICE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1804
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-966-7305
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-11-04
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Provider Licenses
StateLicense IDTaxonomies
MI4801031982207R00000X
MI4301031982207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H24872005Medicare PIN
MI0P30630348Medicare PIN