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NPI Code Detail

MEDICARE: LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC

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 License Number License Number State
1207ND0101XMOHS-Micrographic Surgery Physician
2207Q00000XFamily Medicine Physician
3208200000XPlastic Surgery Physician
4207N00000XDermatology Physician

General Provider Information

NPI Number : 1780842286
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Provider Business Mailing Address
First Line : 2600 LAKE LUCIEN DR
Second Line : SUITE 180
City : MAITLAND
State : FL
Zip : 32751-7233
Country : US
Telephone Number : 407-875-2080
Fax Number : 407-875-0518
Provider Business Practice Location Address
First Line : 6175 NW 153RD ST
Second Line : SUITE 320
City : MIAMI LAKES
State : FL
Zip : 33014-2435
Country : US
Telephone Number : 305-557-6719
Fax Number : 305-279-7709
Authorized Official
Title or Position : PRO SER REP
Name : NEFRITA LOGAN
Credential :
Telephone Number : 407-875-2080
Provider Enumeration Date : 05/30/2008
Last Update Date : 09/24/2010

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