Healthcare Provider Details

I. General information

NPI: 1609443530
Provider Name (Legal Business Name): NICHOLAS G LEVENTIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2252 N MONROE ST
MONROE MI
48162-4254
US

IV. Provider business mailing address

2252 N MONROE ST
MONROE MI
48162-4254
US

V. Phone/Fax

Practice location:
  • Phone: 734-682-5434
  • Fax: 734-244-5184
Mailing address:
  • Phone: 734-682-5434
  • Fax: 734-244-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101028114
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: