Provider Demographics
NPI:1427210418
Name:LEAVITT, KAREN HADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:HADLEY
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:THERESE
Other - Last Name:HADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:230 BENMORE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4101
Mailing Address - Country:US
Mailing Address - Phone:407-622-6022
Mailing Address - Fax:407-622-6100
Practice Address - Street 1:230 BENMORE DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4101
Practice Address - Country:US
Practice Address - Phone:407-622-6022
Practice Address - Fax:407-622-6100
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250537262084P0800X
IL0361254142084P0800X
FLME1206082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID16083169Medicare PIN