Provider Demographics
NPI:1871602573
Name:LEV, RONAN Y (MD)
Entity type:Individual
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First Name:RONAN
Middle Name:Y
Last Name:LEV
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:112 PIPER HILL DR
Mailing Address - Street 2:STE 12
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1690
Mailing Address - Country:US
Mailing Address - Phone:636-244-4205
Mailing Address - Fax:636-244-4209
Practice Address - Street 1:112 PIPER HILL DR
Practice Address - Street 2:STE 12
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1690
Practice Address - Country:US
Practice Address - Phone:636-939-9202
Practice Address - Fax:636-939-9113
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2018-06-13
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Provider Licenses
StateLicense IDTaxonomies
MO2004001649208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208363507Medicaid
MO920100816Medicare PIN
14027Medicare UPIN