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NPI Code Detail

MEDICARE: DR. TIM CHRISTOPHER LEVENHAGEN MD

MEDICARE: DR. TIM CHRISTOPHER LEVENHAGEN MD
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
12084P0800XPsychiatry Physician33398020WI

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 : 1962487256
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIM CHRISTOPHER LEVENHAGEN MD
Provider Business Mailing Address
First Line : 34700 VALLEY RD
Second Line :
City : OCONOMOWOC
State : WI
Zip : 53066-4500
Country : US
Telephone Number : 800-767-4411
Fax Number : 262-646-7067
Provider Business Practice Location Address
First Line : 34700 VALLEY RD
Second Line :
City : OCONOMOWOC
State : WI
Zip : 53066-4500
Country : US
Telephone Number : 800-767-4411
Fax Number : 262-646-7067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2005
Last Update Date : 09/18/2009

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