Healthcare Provider Details

I. General information

NPI: 1720353022
Provider Name (Legal Business Name): DONALD LEVEILLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N FLAGLER DR STE 8200
WEST PALM BEACH FL
33401-3413
US

IV. Provider business mailing address

1411 N FLAGLER DR STE 8200
WEST PALM BEACH FL
33401-3413
US

V. Phone/Fax

Practice location:
  • Phone: 561-612-3200
  • Fax: 561-335-5424
Mailing address:
  • Phone: 561-612-3200
  • Fax: 561-335-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD459123
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD459123
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: