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NPI Code Detail

MEDICARE: GWEN A LEVITT DO

MEDICARE: GWEN A LEVITT DO
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
12084P0800XPsychiatry Physician2656AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871532697
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWEN A LEVITT DO
Provider Business Mailing Address
First Line : 6015 W PEORIA AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85302-1213
Country : US
Telephone Number : 623-344-4400
Fax Number : 623-344-4450
Provider Business Practice Location Address
First Line : 6015 W PEORIA AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85302-1213
Country : US
Telephone Number : 623-344-4400
Fax Number : 623-344-4450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 01/13/2009

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Directions to “ GWEN A LEVITT DO” Practice Location

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