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General NPI Number Information
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NPI Number | 1780995746
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Entity Type | Individual
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Provider Name | ETHAN MYLES LEAVITT D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 485 N KS HWY 2
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City | ANTHONY
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State | KS
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Zip | 67003-2526
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Country | US
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Telephone | 620-914-1200
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Fax | 620-914-1267
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Provider Business Mailing Address
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Address Line | 485 N KS HWY 2
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City | ANTHONY
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State | KS
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Zip | 67003-2526
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Country | US
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Telephone | 620-914-1200
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Fax | 620-914-1267
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 05-42697
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License Number State | KS
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