Healthcare Provider Details

I. General information

NPI: 1265165682
Provider Name (Legal Business Name): MR. LEVI JON LAWRY-SHEFCHIK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2022
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARK ST
MADISON WI
53715-1830
US

IV. Provider business mailing address

422 LUSH WOODS TRL
VERONA WI
53593-8169
US

V. Phone/Fax

Practice location:
  • Phone: 608-260-2900
  • Fax: 608-260-2976
Mailing address:
  • Phone: 608-235-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7961-23
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: