MEDICARE: PATRICK LEO LEVASSEUR DDS

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
1	122300000X	Dentist	15414	MI

General Provider Information

NPI Number	:	1366609372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK LEO LEVASSEUR DDS

Provider Business Mailing Address
First Line	:	11000 HIGHLAND RD
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2153
Country	:	US
Telephone Number	:	248-698-2220
Fax Number	:	248-698-0360

Provider Business Practice Location Address
First Line	:	11000 HIGHLAND RD
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2153
Country	:	US
Telephone Number	:	248-698-2220
Fax Number	:	248-698-0360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	05/19/2008

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