Provider Demographics
NPI:1316944093
Name:LEVCOVITZ, HENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:HENRIQUE
Middle Name:
Last Name:LEVCOVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 412
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4361
Mailing Address - Country:US
Mailing Address - Phone:210-281-8669
Mailing Address - Fax:210-314-5044
Practice Address - Street 1:11398 BANDERA RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6827
Practice Address - Country:US
Practice Address - Phone:210-543-7334
Practice Address - Fax:210-314-5044
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1107208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R7740OtherBCBSTX
TX8C7596Medicare PIN
F73433Medicare UPIN
TX387292YLL2Medicare PIN