Provider Demographics
NPI:1679772719
Name:SIMON A LEVIT, MD
Entity type:Organization
Organization Name:SIMON A LEVIT, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-747-8081
Mailing Address - Street 1:1725 E 19TH ST
Mailing Address - Street 2:703
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5437
Mailing Address - Country:US
Mailing Address - Phone:918-747-8081
Mailing Address - Fax:
Practice Address - Street 1:1725 E 19TH ST
Practice Address - Street 2:703
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5437
Practice Address - Country:US
Practice Address - Phone:918-747-8081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherTRICARE