Healthcare Provider Details

I. General information

NPI: 1346818820
Provider Name (Legal Business Name): OLEKSIY M LEVANTSEVYCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44428 WOODWARD AVE STE 102
PONTIAC MI
48341
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DRIVE STE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8700
  • Fax:
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number4301510607
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: