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NPI Code Detail

MEDICARE: ETHAN MYLES LEAVITT D.O.

MEDICARE: ETHAN MYLES LEAVITT D.O.
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
1207Q00000XFamily Medicine Physician05-42697KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780995746
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN MYLES LEAVITT D.O.
Provider Business Mailing Address
First Line : 485 N KS HWY 2
Second Line :
City : ANTHONY
State : KS
Zip : 67003-2526
Country : US
Telephone Number : 620-914-1200
Fax Number : 620-914-1267
Provider Business Practice Location Address
First Line : 485 N KS HWY 2
Second Line :
City : ANTHONY
State : KS
Zip : 67003-2526
Country : US
Telephone Number : 620-914-1200
Fax Number : 620-914-1267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2010
Last Update Date : 04/18/2025

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Directions to “ ETHAN MYLES LEAVITT D.O.” Practice Location

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