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General NPI Number Information
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NPI Number | 1427216936
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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 | 05/30/2008
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 49 ROYAL PALM PT STE 100
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City | VERO BEACH
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State | FL
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Zip | 32960-4270
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Country | US
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Telephone | 772-569-5056
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Fax | 772-562-5098
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Provider Business Mailing Address
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Address Line | 2600 LAKE LUCIEN DR STE 180
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City | MAITLAND
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State | FL
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Zip | 32751-7235
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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 | DIRECTOR, PROVIDER SERVICES
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Name | AMY DECLUE
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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 | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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