Provider Demographics
NPI:1518073535
Name:LEVENSON, ILENE SINGER (MD)
Entity type:Individual
Prefix:DR
First Name:ILENE
Middle Name:SINGER
Last Name:LEVENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 BAYMEADOWS WAY # 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8236
Mailing Address - Country:US
Mailing Address - Phone:904-396-0450
Mailing Address - Fax:904-346-0212
Practice Address - Street 1:8614 BAYMEADOWS WAY # 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8236
Practice Address - Country:US
Practice Address - Phone:904-396-0450
Practice Address - Fax:904-346-0212
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34310-08257ZMedicare ID - Type Unspecified
FLE22862Medicare UPIN