Provider Demographics
NPI:1083886204
Name:LEIVANT, MEGAN AILEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:AILEEN
Last Name:LEIVANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:AILEEN
Other - Last Name:HORINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13296 FREEHOLD CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8230
Mailing Address - Country:US
Mailing Address - Phone:773-450-8780
Mailing Address - Fax:
Practice Address - Street 1:13296 FREEHOLD CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:773-450-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.119622207R00000X
IN01068687A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01405425OtherMEDICARE RR
IN201001950Medicaid
IN201001950Medicaid