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General NPI Number Information
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NPI Number | 1225323264
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Entity Type | Organization
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Legal Business Name | LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 5353 N FEDERAL HWY SUITE 400
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-3245
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Country | US
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Telephone | 954-489-9800
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Fax | 954-489-0401
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Provider Business Mailing Address
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Address Line | 2600 LAKE LUCIEN DR SUITE 180
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City | MAITLAND
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State | FL
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Zip | 32751-7233
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Country | US
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Telephone | 407-875-2080
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Fax | 407-875-0518
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Authorized Official
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Title or Position | PROIVDER SERVICE REP
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Name | NEFRITA LOGAN
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Credential |
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Telephone | 407-875-2080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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