MEDICARE: LESLIE HAVEMANN, MD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1184366080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE HAVEMANN, MD, PLLC

Provider Business Mailing Address
First Line	:	125 PECAN HOLLOW DR
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-5319
Country	:	US
Telephone Number	:	972-304-6396
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE STE 651
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1906
Country	:	US
Telephone Number	:	972-304-6396
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LESLIE HAVEMANN
Credential	:	MD
Telephone Number	:	972-304-6396

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	04/11/2022

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