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NPI Code Detail

MEDICARE: DR. THOMAS MACKENZIE LEAVENWORTH M.D.

MEDICARE: DR. THOMAS MACKENZIE LEAVENWORTH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician22498IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11346230539OTHERIABLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346230539
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS MACKENZIE LEAVENWORTH M.D.
Provider Business Mailing Address
First Line : 900 STONE MILL RD
Second Line :
City : TIPTON
State : IA
Zip : 52772-9238
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1410 N 4TH ST
Second Line :
City : CLINTON
State : IA
Zip : 52732-2940
Country : US
Telephone Number : 563-244-3641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 08/14/2009

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