MEDICARE: LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207ND0101X	MOHS-Micrographic Surgery Physician
2	208200000X	Plastic Surgery Physician
3	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1407014996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC

Provider Business Mailing Address
First Line	:	151 SOUTHHALL LN
Second Line	:	STE 300
City	:	MAITLAND
State	:	FL
Zip	:	32751-7176
Country	:	US
Telephone Number	:	407-875-2080
Fax Number	:	407-650-3455

Provider Business Practice Location Address
First Line	:	16100 NE 16TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4708
Country	:	US
Telephone Number	:	305-652-8600
Fax Number	:	305-652-3139

Authorized Official
Title or Position	:	DIRECTOR, PROVIDER SERVICES
Name	:	AMY DECLUE
Credential	:
Telephone Number	:	407-875-2080

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	11/20/2014

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