Provider Demographics
NPI:1255303459
Name:LEVSTIK, MARK ALAN (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:LEVSTIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3814 E 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1608
Mailing Address - Country:US
Mailing Address - Phone:303-452-2046
Mailing Address - Fax:303-280-8383
Practice Address - Street 1:13421 QUEBEC STREET
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602
Practice Address - Country:US
Practice Address - Phone:036-731-5703
Practice Address - Fax:036-731-3313
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO41256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71606840Medicaid
COCO307178Medicare PIN