Healthcare Provider Details

I. General information

NPI: 1427210418
Provider Name (Legal Business Name): KAREN HADLEY LEAVITT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN THERESE HADLEY MD

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 KRAFT AVE SE STE 186
GRAND RAPIDS MI
49512-2076
US

IV. Provider business mailing address

2828 KRAFT AVE SE STE 186
GRAND RAPIDS MI
49512-2076
US

V. Phone/Fax

Practice location:
  • Phone: 616-303-3562
  • Fax: 800-742-9838
Mailing address:
  • Phone: 616-303-3562
  • Fax: 800-742-9838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301100376
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME120608
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301100376
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125053726
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036125414
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: