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General NPI Number Information
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NPI Number | 1740312313
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Entity Type | Organization
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Legal Business Name | JEFFREY LEVITT
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3406 CIRCLE DR
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48382-1958
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Country | US
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Telephone | 248-360-3948
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Fax | 248-360-7558
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Provider Business Mailing Address
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Address Line | 3406 CIRCLE DR
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48382-1958
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Country | US
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Telephone | 248-360-3948
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Fax | 248-360-7558
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Authorized Official
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Title or Position | OWNER MANAGING AGENT
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Name | JEFFERY C.A. LEVITT
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Credential | DPM
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Telephone | 248-360-3948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901400153
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License Number State | MI
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