Provider Demographics
NPI:1730161209
Name:LEVINE, ERIC J (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 664050
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-4050
Mailing Address - Country:US
Mailing Address - Phone:317-783-8009
Mailing Address - Fax:317-783-8012
Practice Address - Street 1:4770 S EMERSON AVE
Practice Address - Street 2:STE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-6913
Practice Address - Country:US
Practice Address - Phone:317-783-8009
Practice Address - Fax:317-783-8012
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01043311A2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E93758Medicare UPIN