Provider Demographics
NPI:1457450777
Name:LEAVITT, DAVID M (MD)
Entity Type:Individual
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First Name:DAVID
Middle Name:M
Last Name:LEAVITT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4525 N RAVENSWOOD AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5201
Mailing Address - Country:US
Mailing Address - Phone:734-913-0350
Mailing Address - Fax:734-913-0350
Practice Address - Street 1:107 APRILL DR
Practice Address - Street 2:SUITE 4
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1956
Practice Address - Country:US
Practice Address - Phone:734-903-0350
Practice Address - Fax:734-903-0350
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-12-23
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Provider Licenses
StateLicense IDTaxonomies
CO454752084P0800X
IDM-151882084P0800X
MI43010956242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry