Provider Demographics
NPI:1285790170
Name:LEVINE, MARK E (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:7400 FANNIN ST STE 1118
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1936
Practice Address - Country:US
Practice Address - Phone:713-799-8994
Practice Address - Fax:713-799-9931
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2024-05-02
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Provider Licenses
StateLicense IDTaxonomies
TXL3728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185622101Medicaid
TX8J3787Medicare PIN
TXH18065Medicare UPIN