Healthcare Provider Details

I. General information

NPI: 1912916560
Provider Name (Legal Business Name): LEVESTER KIRKSEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LEVESTER KIRKSEY MD

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 EUCLID AVE
CLEVELAND OH
44195-3304
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2892
  • Fax:
Mailing address:
  • Phone: 216-444-2892
  • Fax: 216-444-4508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD064244L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: