Provider Demographics
NPI:1164602231
Name:LEAVITT, KARLA M (MD)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:M
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KARLA
Other - Middle Name:M
Other - Last Name:LEAVITT CARABALLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:207 W GORE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1014
Mailing Address - Country:US
Mailing Address - Phone:321-841-8555
Mailing Address - Fax:321-841-2425
Practice Address - Street 1:207 W GORE ST STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1014
Practice Address - Country:US
Practice Address - Phone:321-841-8555
Practice Address - Fax:321-841-2425
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132560207VM0101X
PR11767 I207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105939000Medicaid